Care in the Community: Patients 'left isolated and destitute': Policy for rehabilitating mentally ill people is failing in practice, select committee finds
Lack of resources and services, failure of government departments and local authorities to liaise and produce a co-ordinated national strategy, and a total absence of information on the numbers of mentally ill people and services provided for them are condemned in one of the most critical reports of government policy by a Tory-dominated select committee.
'Community Care has failed miserably, as I always said it would, unless it was funded properly,' Alice Mahon, a Labour member of the committee, said yesterday.
The committee stressed it was committed to the principles behind the policy of successive governments of closing long-stay psychiatric institutions and caring for more mentally ill people in the community. But after an inquiry the committee concluded the system is failing in practice.
Conditions in hospitals are overcrowded and unsuitable, there is a shortage of alternative facilities in the community and many mentally ill people are left isolated, destitute and homeless, especially in inner cities. The system has also failed to protect the public from the few mental patients who are dangerous. Jayne Zito - whose husband Jonathan was stabbed to death by Christopher Clunis, a paranoid schizophrenic who had been discharged from Guy's Hospital, London, without adequate supervision - said the report was very thorough. 'But one of the things that is missing is a statement of who is accountable when services are not provided and when tragedies do happen and lives are lost . . . Despite the Government's negligence, the professionals on the ground have to be accountable.'
Because of the lack of definition of serious mental illness, estimates of sufferers range from 1 person in 20 to 1 in 500. Forty years ago there were 150,000 beds in psychiatric institutions; today there are fewer than 50,000. Care in the Community was supposed to provide alternative services for those who in the past would have been in hospital, but the report shows it has failed dismally.
The provision of acute, medium term and day care, emergency and crisis care, treatment of mentally disordered offenders, and protection for and from the public are all criticised. The MPs say: 'We are deeply concerned at the intensity of pressure faced by the providers of acute care for the mentally ill in some inner cities. It is wrong that vulnerable and, in some cases, potentially violent individuals may be discharged abruptly, inappropriately and without adequate support into the community.'
Summarising the report, Marion Roe, committee chairwoman, said: 'We are very concerned by the lack of co-ordination between government departments to ensure a consistent national policy for the care of seriously mentally ill people. The Department of Health's own 'Homeless Mentally Ill' initiative has been hampered by delay in developing permanent supported accommodation, and this has been due to deadlock between the various agencies involved over where responsibility lies for revenue funding . . . While agencies squabble . . . people who are seriously mentally ill may be left in poor housing or be homeless and without support.'
The MPs say local authorities should be required to include in their annual community care plans a clear statement on the number of residential places they will make available for the severely mentally ill, and that an inter-departmental task force should be set up urgently to meet their housing needs. The report makes a series of recommendations including: ring-fencing of funds released by the closure of hospitals; an urgent review of mental health services in inner cities; a social deprivation score to be included as a weighting factor in resource allocation; publication by the Department of Health of an operational definition of serious mental illness for strategic planning; introduction, within one year, of an on-going system of collection and analysis of information of service provision; and better co-ordination and communication between local authorities to improve mental health services.
John Bowis, Under-Secretary of State at the Department of Health, said: 'Changes cannot happen overnight and we will consider the recommendations very carefully, but we are already taking a number of positive steps to improve the care in the community for this vulnerable group.'
The report did not put a cost on providing the extra resources, but the National Schizophrenia Fellowship estimates that another pounds 500m a year would be needed.
The mental health charity Sane called on the Government to guarantee funding for local authorities to provide adequate mental health services; to slow down the closure of the remaining 47 psychiatric hospitals and improve the quality of staff training.
Better off in the Community? The care of people who are seriously mentally ill. Health Committee First Report; HMSO; pounds 10.
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