Leading Article: Empty gestures fail the mentally ill

THE National Health Service and Britain's welfare agencies work well for people who fit in with their bureaucratic ways. But for someone who is mentally ill, perhaps homeless and certainly in need of long-term support, they are fragmented and ineffective. These institutions may feel they do their bit but collectively they often fail to take responsibility for the individual's continuous care.

Add to this a dangerous shortage of psychiatric beds, doctors, social workers and sheltered housing, and it is not difficult to understand how Christopher Clunis came to be on a railway platform on 17 December 1992, mentally deranged and brandishing a knife with which he killed Jonathan Zito.

Yesterday, the dead man's wife, Jayne, summed up the public's image of community care: 'It is not working well, it has never worked well. It is in crisis, it is not working well because Jonathan Zito has died.'

The report of the inquiry into the killing, published yesterday, provides ample evidence for this conclusion. 'The more disturbed Christopher Clunis became, the less effective was the care he received,' the authors remark. When he needed secure accommodation, no hospital bed was available. The police turned a blind eye to his violence. Medical services lost all trace of him for seven months.

Shocking though this evidence is, the Clunis case has been novel only in the publicity it has attracted. Ministers have been embarrassed before, issued new guidance, thrown a little money at the problem. Yet 30 years after the asylum closure programme began, many mentally ill people are

neglected.

It is perfectly possible to make these services work. If mentally ill people carried a dangerous and highly infectious disease, the Government would be quick to devise, enforce and pay for a way of keeping track of them. It would not take 30 years to set up a national register of people at risk of serious relapse. Sufferers would not be passed between institutions that remained ignorant of their medical histories.

Yet because psychiatric illness imposes its burden principally on sufferers and their families, politicians - and many providers of services - have all too often contented themselves with empty gestures about offering better care. The killing of Jonathan Zito finally made such complacency untenable.

Yesterday Virginia Bottomley recited a litany of what has been done to improve mental health care. This is not enough. She should impose minimum standards for staffing and facilities in the NHS and replace her voluminous but much-ignored 'guidance' with binding directives. It is a step her predecessors have avoided because they would not pay for proper services. Jonathan Zito's death demands nothing less.