Mental illness is on the rise. It has also become one of the biggest, and least-resourced, burdens on the Health Service. Which is why successive government have been so keen to move the problem out of the expensive care of hospitals into the more diffuse, and less expensive, mercies of the outside community.
The move has come with its own problems of distraught families, overstretched local social care services and the personal tragedy of individuals left unsupported in the street. That much is well attested, if too little addressed. But what has received less attention, and even less care, is the fate of those who have remained in care. By their nature, their illnesses are more severe and their situation more desperate than those let out. And yet their plight has remained largely unsung.
Yesterday's report by the Healthcare Commission, described without exaggeration as the "largest-ever review of acute inpatient mental health services", goes some way to restore the balance. Its picture of the comparative quality of services (why must every government report now be couched in terms of comparative rating – which only confuses the issues) is a disturbing one.
Not one of the trusts reviewed scored "excellent" across all four key criteria. Only 10 per cent were generally "excellent". Well over half were judged as only "fair" or "weak". The healthcare watchdog is at pains to point out that there are a number of trusts that provide very good care – showing that it can be done. But the worrying feature of the report is that these tended to be in lower-population areas. The big urban trusts were largely found wanting.
It doesn't take a great deal of intelligence, or even research, to work out the basic difference between good and bad care. Strip the report of its jargon (of which it is distressingly full) and you find that at the best hospitals patients are involved in their treatment, are kept in a safe environment and that their cases were monitored by outside services.
Look at the majority of hospitals and you find that in only half the cases were patients involved in their care plans, that hospital security was lax, violence against staff all too common and relations with services in the community lacking.It's a picture that the families and friends of those committed to hospital know all too well. But it is a story that no civilised society should tolerate.