The discipline of community psychiatry attempts to address how resources can best be allocated for patients outside hospital, and seeks to compare possibly expensive alternatives such as increased numbers of community psychiatric nurses and community treatment or supervision orders. It remains critically blinkered in examining more cost-effective advances in other areas of psychiatric research that deserve equal public debate and a fair hearing in any public outcry for increased funding.
For example, new drugs such as clozapine are transforming the treatment of schizophrenia. This drug can dramatically improve up to 60 per cent of severely schizophrenic patients, allowing them and their families to live their own lives, yet the vast majority of patients in the UK have been unable to obtain this treatment and are channelled into expensive community projects, on old-fashioned drugs, on the premise that psychopharmacology has nothing to offer them.
When scarce monies are being allocated to evaluate community treatment, it should be remembered that patients have a right not only to the best psychological and social interventions, but also to the best drug treatments.
R. W. KERWIN, Senior lecturer and Consultant Psychiatrist, National Psychosis Unit; Dr L. S. PILOWSKY, Dr K. R. LLOYD, Lecturers in Psychiatry
Institute of Psychiatry
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