Today sees the conclusion of the four-part series by Patrick Cockburn, The Independent's distinguished foreign correspondent, on the curse of schizophrenia accompanied by vivid testimony from his son, Henry, who has had the illness for more than a decade.
This powerful series of articles has shone the spotlight on a condition too often consigned to the shadows. It has focused on three aspects – the role of cannabis as a cause of schizophrenia, the "failure" of community care, and the enduring stigma that militates against open discussion and keeps the problem hidden.
On all three points, father and son make a convincing case. Evidence is now overwhelming that cannabis use can trigger the illness in people with a genetic vulnerability. The risk is still small, perhaps 2 per cent for occasional smokers and rising to 8 per cent for regular users of skunk, but it has grown as the strength of the cannabis on the streets has risen and the average age of smokers has fallen (the early adolescent brain is most vulnerable).
The closure of asylums and the switch to community care has been marked by scandal after scandal over the past 50 years – of neglect, abuse and abandonment. Doctors hailed it as de-institutionalisation, but care in the community was too often seen as an opportunity for cost-cutting and became "couldn't care less in the community".
Here, however, the picture is more complex. The development of anti-psychotic drugs in the 1950s allowed hundreds of thousands of patients previously incarcerated in institutions to leave and make better lives outside. That was an unqualified success. But as the movement advanced, more severely ill patients were discharged in need of greater support, and that was lacking. The cash saved from closing asylums was diverted into cancer and heart disease instead of the day centres and outreach teams that it should have funded. Community care did not fail, it was never properly tried. Even Henry appears to agree: "Being institutionalised squashes your dreams," he wrote.
And then there is the stigma. Patrick Cockburn recounts how one of the most disturbing discoveries he made after Henry became ill was that friends had had similar experiences – but never spoken about them. Schizophrenia is the hidden illness, kept secret by families who fear their loved ones will be shunned, ostracised and become unemployable.
So what is to be done? First, mental health must rise up the political agenda. There are some encouraging signs. In a speech last month, Ed Miliband, the Labour leader, declared mental illness the "biggest unaddressed health challenge of our age" and pledged to give mental patients the same legal right to treatment as those with physical illnesses. The Government then announced that mental health would be given equal priority under the NHS mandate. Not before time – there is a 15- to 20-year mortality gap between the mentally well and mentally ill that would be regarded as a scandal in any other group. These pledges are welcome, but must be matched with action. The omens are not good. Mental health budgets are being cut for the first time in a decade, and Mind, the mental health charity, reports that crisis care is understaffed, under-resourced and struggling to support people at a critical point in their lives.
"Mistreatment of the mentally ill is the true test of any community because they are its weakest and most voiceless members," Patrick Cockburn concludes. Ministers must heed that warning and demonstrate that they care enough to redress the omissions of the past.Reuse content