Now in his early thirties, James has lived in Newcastle since his teens, but the soft, melodious accent of the west of Ireland is still strong. He is very bright and can be charming, but is aggressive and defensive by turn as he holds forth on the public's perception of Care in the Community.
"People seem to think you have less value to society because you have schizophrenia - some psychiatrists even. Keep them in hospital. But for most of us, it is better out here. My medication has been lowered and I feel much more secure."
James attributes his stability to the horticultural project he attends, creating and maintaining a garden at the Dene, an old people's home in Newcastle. It is one of several innovative ventures for the mentally-ill being pioneered in the city.
He spends five days a week there and is conducting his own research to see if horticultural therapy can help in reducing the length of a hospital stay. He believes that if you "keep somebody's mind active" then "there is less time for psychotic episodes".
Dr John O'Grady, a consultant psychiatrist and divisional manager for mental health services at Newcastle City Health NHS Trust, agrees. Care in the Community for all but the most severely mentally-ill is really very simple, he said. "It is about having a home, something meaningful to do, and having contact with someone."
These are the guiding principles behind the services the mental healthcare team are trying to provide in Newcastle. There is the Grange, in Longbenton, which provides in- patient care in a non-hospital setting and home psychiatric visits for up to 500 patients each year. The success of this pilot project has been recognised nationally, and locally, the "formula" is being adapted to serve the west end of the city, one of the most deprived areas in the country with a high level of mental illness, according to Dr Suresh Joseph, a consultant psychiatrist at the trust.
The new scheme aims to prioritise people in the community with severe and long-term mental health problems - the group for whom 15 years ago long-term care in an institution was the answer. Whereas previously, the only option for helping patients in a crisis was admission to hospital, there is now an expanded service which came into operation less than two months ago. "The last thing we want to do is stop hospital admissions for the people who really need it, but we are trying to get away from using hospital just because there is nothing else available," Dr Joseph said.
Now, if a patient is in crisis at the weekend or late at night, there is a Rapid Assessment Service which, once alerted by the GP, social worker, a relative or a neighbour, will conduct a home visit and determine the seriousness of the case.
The community psychiatric nurse will have access to the patient's records and know the background. "Sometimes, all they will need to do is arrange a visit from a friend or neighbour or involve the social services," according to Dr Joseph.
For patients who are ready to move back into the community, there is a partial hospitalisation programme, to ease the transition. A key worker may visit the patient at home for 10 or 12 sessions a week, initially, reducing the visits as he or she adapts to life outside a hospital ward. Finally, the jewel in the crown of the service is the Home Support Project, in which experienced auxiliary nurses visit patients and their families up to three or four times a week.
"It is not perfect but it is a step in the right direction. We are trying to give people a better quality of life in a way that is safe and effective. But it doesn't always have the impact we would like - the problems are just so great," Dr Joseph said.Reuse content