‘Care in the Community’ is the expression used in Britain for the policy whereby residential psychiatric institutions are either reduced or eliminated, with sufferers of mental health disorders being cared for in their homes with the support of community mental health services. Similar policies known by various names – e.g. ‘Deinstitutionalization’, ‘Community Release’, etc. – have been followed in many other countries, including the United States.
In various comments I have made, I’ve tended to speak in favour of the policy – while also acknowledging that it is not without its problems. Given my particular interest in children’s psychiatric services, I have argued that it is far better for a child suffering with depression (for example) to be cared for in as normal and homely an environment as possible, rather than being ‘locked away’ in an institution as though he or she were a young offender.
In my blog of 21 February 2011, I reviewed Patrick and Henry’s Cockburn’s book, Henry’s Demons (published by Simon & Schuster). Patrick Cockburn is particularly vocal in his criticism of ‘Care in the Community’. He describes the expression as ‘one of the most deceptive and hypocritical phrases ever devised by a government’. As the old psychiatric institutions were closed down in the 1980s and ’90s, Cockburn argues that those patients who had known some level of protection in these places were suddenly flung out onto the streets to become ‘sidewalk psychotics’.
I have some sympathy for Patrick Cockburn’s position. After all, he has faced the difficulty of trying to secure the safety and effective treatment of his son Henry, a sufferer of schizophrenia, in a world of what he calls ‘couldn’t care less in the community’. Indeed, Cockburn presents a persuasive argument, seeing the closure of many psychiatric hospitals as nothing more than a money-saving measure leading to ‘cruelty and unnecessary misery’.
It is, of course, perfectly true that community-based psychiatric services are often poor to non-existent (depending on region), and that many troubled people are left neglected. But just take a look at The Light in My Mind by Joyce Passmore (published by Speak Up Somerset), or my own book, Delivered Unto Lions (published by CheckPoint Press), to see the other side of the coin. These are reminders of the horrors of institutional ‘care’ in the recent past. Surely, whatever the failures of ‘Care in the Community’ might be, we cannot wish to return troubled people (young or old) to these repugnant places of incarceration.
It is also the case that we have been seriously misled if we are to believe that residential psychiatric care no longer exists. It is true that the larger Victorian-style asylums have gone, as have many of their associated children’s units, but that is not to say that in-patient mental institutions have completely disappeared. I was very surprised to discover that there are roughly seventy-five children’s and adolescents’ residential mental units – run by the NHS (National Health Service) – in the UK today (plus several more privately run units).
My hope is, of course, that these units of today are more caring and empathetic places than the ones that existed in the past. But given that their existence is hardly common knowledge, what happens inside them – good or bad – is hidden from our view.
And this, I think, brings us to what might be the central issue. These places are hidden, and maybe this is what we as a society prefer; we don’t want the mentally and emotionally disturbed living among us. Perhaps this is why many of us don’t like ‘Care in the Community’. Maybe we would prefer damaged and troubled individuals – adults and children – to be shut away where we can’t see them. It isn't nice to think about these things, so perhaps we prefer the easy option of not having to – that is, until we or our families are affected personally.
In this time of austerity, when already hard-pressed services are likely to face further cuts, I would dare to suggest that ‘Care in the Community’ can still work, and work well, but only if we as a community actually start to care. After all, even in hard times, we are perfectly prepared to do our best in supporting the people we care about.
Delivered Unto Lions by David Austin is published by CheckPoint Press
For more information visit www.davidaustin.eu