Studies on care of mentally ill show 'unequal lottery'

TREATMENT of mentally ill people is an unequal lottery, according to three studies released yesterday.

Whereas those leaving Victorian asylums get model care, others are turned away from general hospitals because of ward closures and languish in bed and breakfast hostels.

The studies led to calls for the Government to help 'revolving door' patients who never stayed in asylums but did the rounds of sleeping rough, spending short spells in hospital and prison.

The details, set out at a major London conference on psychiatric services, describe how one London area last year lost one quarter of its psychiatric beds as the number of patients rose by nearly 20 per cent.

The crisis in Bloomsbury and Islington meant that the numbers refused a bed trebled and those admitted were discharged a fortnight earlier than usual.

Dr Robert Sammut, who conducted the study, told the conference, hosted by the Team for the Assessment of Psychiatric Services (TAPS), of plunging staff morale, overcrowding and unacceptable violence. Since then, pounds 1m has been injected into the service. However, mentally-ill people are gravitating to other crisis-hit London areas at a time of swingeing cuts.

A study of bed and breakfast hostels in Southend found schizophrenics living in delapidated conditions, with poor medical back-up. Research shows neglect leads to serious deterioration in patients who end up in hospital, prison, homeless or dead.

The London Hospital Institute of Psychiatry found that 'all bed and breakfast residents in two of the hotels studied had had psychiatric admission in the past'. Few had come from asylums, but 70 per cent were schizophrenic. Many of them were not in contact with psychiatric services, which were 'less than adequate'.

In contrast, latest figures from a study conducted by TAPS to monitor the flagship London closure programmes at Friern and Claybury long-stay hospitals, show patients thriving in the community. Professor Julian Leff reported that, after the first year, only 6 out of 500 patients had become vagrant and the rest showed no changes in mental state or problems with behaviour.

These patients had been the subject of long-term planning and have been accommodated successfully in staffed group homes of about five people.

A follow-up two years after discharge reports significant increases in levels of anxiety, phobia and incontinence combined with increased psychotic behaviour and a fall-off in friendships.

However, Dr David Dayson of the Maudsley Hospital, south London, who did the follow-up, found no overall increase in readmissions. Patients were better able to cook for themselves and did not wish to return to the old asylums.

Jerry Westall, of the National Schizophrenia Fellowship, said: 'Clearly, there is good news about patients from the old asylums. These elderly, long-stay patients are doing well. Meanwhile, thousands of seriously ill, often younger, people are in and out of general hospitals which are overcrowded, or even turn them away. Proper attention must be paid to their plight.'