LEADING ARTICLE : Care endangering the community

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The Independent Online
The killing of Georgina Robinson was a landmark in the history of care in the community. This was not just another preventable death on the streets perpetrated by a patient who had slipped through the net. Ms Robinson, an occupational therapist, was killed in a mental health-care centre, a setting specially designed for community care. Her attacker, Anthony Robinson (no relation), was a resident. The event demonstrated how dangerous community care can be even when it is actually available.

There were many problems about how Mr Robinson was treated. The NHS must take responsibility for these operational failures. But regardless of the mistakes made at this particular centre, Ms Robinson's death highlighted a major and widespread failing in the system. Staff have virtually no powers to act when patients such as Mr Robinson do not take their medication. Under the 1983 Mental Health Act, compulsory treatment can be administered only in a hospital.

This is a serious flaw in a law that is now out of date and should be reformed. Without provision for compulsory treatment in the community, families and doctors are left with only the option of admitting difficult patients to overstretched hospitals.

Everyone knows what has happened as a result. Hundreds of ex-patients have lost touch with the agencies involved in their care and now have miserable lives. At worst patients have become a danger to themselves and to others.

Belatedly, ministers have been shamed into action. Supervision registers are now required for those considered a risk. Psychiatric patients must be followed up after discharge. But these changes are mere meddling. As patients grow sicker in the community, they still miss appointments, fail to take medication and almost inevitably receive less and less care.

Yesterday Sir Louis Blom-Cooper's inquiry into Ms Robinson's death grasped the nettle and demanded fundamental changes to the 1983 Mental Health Act. The proposals would end the chaos of community care: the authorities would have to give a precise prescription of where patients should live and the treatment they must receive, compulsorily if necessary.

Civil rights would have to be protected. But vulnerable people would at last be sure of a decent life in the community. Psychiatric services would no longer be able to shirk their responsibilities. The Government would have to pay the bill.

If these proposals are ignored, we can only assume that ministers prefer the cheaper, dangerous status quo. If so, they must accept responsibility for the future scandals that will surely follow.

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