Letter: Drug treatments denied to psychiatric patients in the community

Sir: While welcoming the concern generated by the lamentable incident involving a schizophrenic man at London Zoo, we are concerned that the consequent debate about community psychiatry is rather one-sided. The notion of community care has at its nub a chronically sick patient, non-compliant or denied access to appropriate treatment, entering the lions' den at the London Zoo, or, in Professor Andrew Sims's imagery (report, 4 January), 'the spectre of a community nurse attacking a patient with a syringe on the kitchen table' - a bizarre reversal of the dangers faced by mental health professionals working in the community.

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.

Yours faithfully,

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

London, SE5