LETTERS: The goal is to keep mentally ill patients out of institutions

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The Independent Online
From Dr Robert W. Kerwin Sir: Following the report by Sir Louis Blom-Cooper on the tragic death of Georgina Robinson, may I remind you of my letter to your readers at the time Ben Silcock was mauled by a lion in the context of an impotent community system. My point then is still relevant now - community care has become a monolithic orthodoxy of its own right that has failed to keep pace with advances in the drug treatment of schizophrenia.

It is no media secret that Mr. Silcock was subsequently referred to my care for treatment with a superior new drug, Clozapine, and has done exceptionally well. He is symptom free and is no longer the "revolving door" community patient, a situation which bedevilled him for years. Two-and-a-half years on, the Blom-Cooper report is still recommending further improvements in community care and the Mental Health Act. However, it is still the case, despite these recommendations, that only 2,500 of a pos sible55,000 patients are on Clozapine and most of these patients who would benefit are of the same ilk as Messrs. Silcock and Robinson.

I have treated 52 such patients with Clozapine since 1990 with only two relapses. The reason for the low use of this drug is cost. However, many studies show clear-cut cost utility savings to hospital and communities as a result of dramatic clinical improvement on new antipsychotics. Nevertheless, hospitals prefer to spend large sums of money on an overstretched community care system while starving pharmacies of the modest cost of Clozapine and other new drugs.

I fully agree with Sir Louis that de-institutionalisation should remain the overall goal and that doctors and mental health workers in the community should have greater powers. But surely this would be made much easier by the wide availability of more effective treatments. In a quality health service, this bi-lateral approach is no more than these tragic cases deserve.

Yours sincerely, ROBERT W. KERWIN Reader in Clinical Neuropharmacology National Psychosis Unit Institute of Psychiatry London, SE5

17 January