Letter: Pioneers and victims of care in the community

Sir: More than a decade ago I predicted that the then new care in the community programme would come to grief as more people were discharged from mental asylums inappropriately. The Community Health Council, of which I was a member, heard my protests but could do nothing to counterbalance the polemic of civil liberties which pervaded policy decisions concerning the management of people with mental illness. The sad case of Christopher Clunis ('The tragic scandal of a schizophrenic killer nobody stopped', 19 July) is the latest proof of my assertion.

As a GP, I had two violent patients in the community whom I felt ought to be in secure units. One killed himself. The other assaulted me, and I have no doubt would have stabbed me had he had a knife to hand. My attempts to have him sent to a secure unit by the court were thwarted by the Crown Prosecution Service, which decided not to prosecute. Many GPs could tell similar tales.

Of course, the majority of mentally ill people are safe and can benefit from care within the community, but a minority of patients need the security, safety, withdrawal from society and space that the old-style asylums gave. We need modern units, by whatever name, which are large enough to allow patients to mingle with different groups of people as moods change yet small enough to be homely. This builds on the benefits of asylums without repeating their mistakes, and no amount of community care can do this. The opposite of a bad asylum is a good asylum, not a closed one.

Yours sincerely,

JOHN D. WILLIAMSON

Hove, Sussex

19 July