It is a sine qua non that patients will use a successful psychiatric service willingly, and that the need for compulsion will progressively decline. This was the situation here until 1979, when the tide turned. Even with a new liberal Mental Health Act, compulsion is increasing each year, and voluntary admissions after a period of stasis may even be in decline.
The Mental Health Act Commission confirms that 60 years of progress is being dissipated and hospitals are again becoming centres of detention. The central reason for this is that a shortage of beds delays admission until co-operation is lost and mental deterioration leads to compulsory admission in a crisis situation or by a remand in prison while a bed is being sought. At the same time, pressure for discharge results in inadequate treatment, the likelihood of early relapse and ever-increasing speed of the so-called 'revolving door'.
The Junior Minister of Health is clearly out of touch, being widely quoted on 5 October as saying that the number of places for patients has remained constant, at about 80,000, since 1980. In fact, there were 112,000 resident patients that year, and the number had already declined by 27 per cent by 1990. Nevertheless, he promised 70 more hospital closures within the next seven years. The Mental Health Act Commission apparently believes that 20 per cent of patients currently resident can be discharged to hostels and homes.
Not only will a large number of demands for periodic readmission arise from this group but the 'market' will also guarantee that a vacated place is closed even sooner than before.
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