Care in the Community

Care in the Community was a policy of the Margaret Thatcher government in the 1980s. Its aim was a more liberal way of helping people with mental health problems, by removing them from impersonal, often Victorian, institutions, and caring for them in their own homes. Also, better drugs became available and this meant that patients could be treated at home. It was also meant to reduce the cost of institutionalizing so many mentally ill people.

Although there have been some murders by a few people in the community with mental health problems, the truth is that it is far more likely that someone with mental health problems will be subject to attack by someone who is healthy themselves.

The National Health Service and Community Care Act 1990 was passed so that patients could be individually assessed, and assigned a specific care worker; in the unlikely event that they presented a risk they were to be placed on a Supervision Register. But there have been some problems with patients "slipping through the net" and ending up homeless on the street. There have also been arguments between Health and Social Services departments on who should pay.

In January 1998, the Labour Health Secretary, Frank Dobson, said the care in the community programme launched by the Conservatives had failed ("Care in the community to be scrapped, BBC, 1998". Retrieved September 26. ).

The situation in London has long been particularly difficult. People with psychiatric problems, particularly drug and alcohol abuse, and schizophrenia gravitate to London from all over the world and from all over the country. However, funding for health care in London has been redistributed to the provinces and the proportion of the overall NHS budget spent on mental health services has declined from 11% to 9%. Many psychiatric beds have been closed. In order to get better psychiatric bed utilisation, psychiatric wards became mixed sex wards and the pressure on beds has meant that the level of disturbance on the acute psychiatric wards has become much greater.

Some of the resultant initiatives have been largely cosmetic. For example, assertive outreach has been widely promoted for difficult cases. The team have a small caseload and are able to dedicate intensive resources. In consequence, the teams often have a waiting list of years and are only prepared to accept patients with severe, treatment resistant schizophrenia.

References

Weller M P I Mental illness - who cares? Nature 1989 399: 249-252.

Weller M.P.I., Sammut R.G., Santos M.J.H. and Horton J. Whose sleeping in my bed? Bulletin of the Royal College of Psychiatrists 1993, 17: 652-654.