Questions and Answers

Questions and Answers...

From Tom;

Q: Can you comment on how the shift to the community care model affected services for mental health service users?

A: Yes. Since the early 1950s, psychiatric hospitals in Europe have been running down. It has been estimated that over half a million long-stay patients have been discharged from psychiatric hospitals in the US and UK combined. This massive change in care has been endorsed by successive British governments since 1967, when then health minister Enoch Powell predicted the closure of 75 000 beds in asylums over the next 15 years.

Q: And how successful has the shift to community care in mental health been?

A: Before 1984, problems in mental hospitals dominated the public agenda. Since then, attention and blame have shifted almost completely to community care. Even when incidents occurred in hospitals, care in the community seemed suddenly to play a significant part. This raises several important questions, such as …did hospital care before the 1980s prevent community scandals?... Has mental health care deteriorated since then? … and are people with mental health problems dangerous in the community?

Statistics show worrying results post the shift to the community care model. In 1996, when 1200 000 beds were available for mentally ill people in the UK, compared to 57 000 in 1990, a study in east London followed up people discharged from hospitals. Only 54 per cent of patients with schizophrenia discharged to known addresses could be traced after a year. Only about one third of these lived in satisfactory circumstances and a third neglected themselves. In the early 1990s, several studies give an idea of the state of community services. A survey in west Lambeth followed up 140 patients with schizophrenia after discharge from an acute unit. After a year, only one patient was lost to the services, but four had died, 3 from probable suicide.

Here, we should also highlight what has come to be labelled ‘scare in the community’. Until 1981, inquiries into psychiatric care hade addressed scandals in hospital on behalf of an angry public, almost invariably showing patients as helpless vicvtims and staff as abusers. In 1981, a shocking event had major repercussions for mental health care and public attitudes. Sharon Campbell, a former in patient, killed Isabel Schwarz, her former social worker, at Bexley Hospital. From then on, community care became associated with danger.

Anna's question by against side for for.

It surely wouldn't be practical to shift all those in need of care back into the family home. What about those families who simply don't have room to take on a caring role?

It is true that it wouldn't be practical for community care to simply take place in the family home, but it is important to remember the vast numbers of carers who have dependents in other households. Of these just over a fifth are looking after parents or parents in law, and a fifth are caring for relatives other than parents or children. This may not be in the family homes, but still represents a shift of responsibility to the family.