LEADING ARTICLE: How scared do we need to get?

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When people get scared they take notice: that is what is happening with Britain's creaking system for caring for the mentally ill.

A string of killings by psychiatric patients has pushed the Government into action. In the past couple of years hundreds of mentally ill people have been taken out of the prison system and off the streets and put into the NHS. Orders have been issued from on high in the Department of Health that doctors should only discharge psychiatric patients into well managed community care schemes. More hospital beds, though probably too few, are promised for the long-term ill.

Yet these measures hardly match the grim picture painted by yesterday's report from the Royal College of Psychiatrists on homicides and suicides by the mentally ill. It describes overcrowded hospitals, where the ill are forced out to make way for the even more seriously disturbed. Psychiatrists are quitting the NHS because they have become so concerned at the state of the system. Community care is often little more than decrepit bedsits where the mentally ill eke out isolated lives, out of touch with health and social services until their condition deteriorates to a point where they have to be readmitted.

In short, the system is in a mess. Better management of the pounds 2bn a year we already spend on caring for the mentally ill would help. If, however, we are serious about tackling the mental healthcare crisis, the financial consequences must be accepted.

Extra resources the system needs should be focused on two areas. First, there are two few institutions - hospitals, secure units, nursing homes - offering places for the long-term sick. Many of these patients have come out of the prison system or were homeless and need long-term, medically supervised, sometimes secure, accommodation, which is in chronically short supply. Such accommodation can be provided by both the public and the private sector.

Second, we need an improved infrastructure to support mentally ill people in the community so that they do not turn to hospitals as their first port of call. Community services often shut down from 5pm to 9am on weekdays and for the entire weekend. Local "crisis houses" with 24-hour nursing care and social support are needed. A small army of carers is required to support people at home.

None of these policies is controversial. Together, they would take the strain off hospital psychiatric wards, which are fast turning into dangerous bedlams for the insane. But at present all this is just a dream.

The reason is that mental health cannot compete politically with demands for shorter waiting lists. This week's report on psychiatric patients will worry those fearful of being murdered; it will arouse anger about neglect of the suicidal and vulnerable. But it will not produce the same results as last week's row about people waiting hours for treatment at casualty departments because there are too few beds and junior doctors.

Politicians know where most votes are lost and won. They invest accordingly. What's missing is serious leadership prepared to make the public realise that better mental health care means less of something else. So far, no political party has been brave enough to spell out the choices. With the misery of neglect so evident, it is time to face that challenge.

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