Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-24T02:02:45.742Z Has data issue: false hasContentIssue false
  • English
  • Français

Community Care and the Discharge of Patients from Mental Hospitals

Published online by Cambridge University Press:  29 April 2021

Philip Bean  and
Patricia Mounser
Get access Rights & Permissions [Opens in a new window]

Extract

In Britain the movement towards “Community Care” gathers apace. Segregation techniques in their traditional forms are steadily losing ground to newer community based alternatives. Both America and Britain have seen a massive reduction in the register of patients resident in mental hospitals; specifically in America from a peak of 560,000, and in Britain 165,000 in 1955, to some 273,000 and 70,000 respectively. And how has this been achieved? Through the rhetoric of “community care,” whose influence over policy in hospital admissions and discharges has been particularly remarkable, according to Peter Sedgwick, in that it does not in reality exist. America has been swift to adopt this new panacea “community care” where the emptying of asylums has turned out to have unforeseen problems. Creedmoor asylum for the borough of Queens in New York released 3,000 patients within a few months. Britain has been rather slow to follow—perhaps a little less ruthless—but the reduction of beds continues.

Type
Article
Information
Law, Medicine and Healthcare , Volume 17 , Issue 2 , Summer 1989 , pp. 166 - 173
Copyright
Copyright © American Society of Law, Medicine and Ethics 1989

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cohen, D., Forgotten Millions: The Treatment of the Mentally Ill, a Global Perspective. Paladin Grafton Books: London, 1988.Google Scholar
Sedgwick, P., Psycho-politics, Pluto Press, 1982.Google Scholar
Cohen, , supra note 1, p. 14.Google Scholar
See Scull, A., Decarceration: Community Treatment and the Deviant, A Radical View, Prentice-Hall, 1977, Chs. 4 and 5, and Scull, “The Asylum as Community and the Community as Asylum,” in Bean, P.T., (ed) Mental Illness: Changes and Trends, John Wiley and Sons, 1983.Google Scholar
Cohen, , supra note 1, p. 93.Google Scholar
Id.: 195.Google Scholar
Id.: 95.Google Scholar
This phrase was taken from a Report commissioned by the Secretary of State for Social Services by Griffiths, Sir Roy, entitled Community Care: Agenda for Action H.M.S.O. 1988.Google Scholar
Id.: Para. 9.Google Scholar
Id.: Paras. 3.2 and 3.3.Google Scholar
H.M.S.O. (1984–5) House of Commons Committee on Social Services, Evidence from the D.H.S.S. (H.C.13 1984–5). The full definition given in this report is as follows: “Community care enables individuals to remain in their own homes wherever possible rather than be cared for in hospitals or residential nursing homes. It aims to give support and relief to informal carers, (family, friends, and neighbours) coping with the stress of caring for a dependent person; to deliver appropriate help by the means which cause the least possible disruption to ordinary living, to relieve the stresses and strains contributing to or arising from physical or emotional disorder; to provide the most cost effective package of services to meet the needs and wishes of those being helped; and to investigate all the resources of a geographical area in order to support the individuals within it.”Google Scholar
For a discussion on Sectorisation as it operates throughout Europe, see Walsh, D., (1983) “Mental Health Service Models in Europe,” in W.H.O. (ed) Mental Health Services in Pilot Areas. W.H.O. ch. 4. And for an assessment of Sectorisation generally, see Turner, R.J. et al. (1987) Bulletin of the Royal College of Psychiatrists, Vol. 11 No. 4 April.Google Scholar
Greater Nottingham is defined as including Nottingham, Rushcliffe, Broxtowe, and Gedling. It contains an estimated population for 1985 of 585,330 based on the Population Estimates from Social Services Department (1986).Google Scholar
These are provided by the Mapperley group of Hospitals, Mapperley (scheduled for closure around 1992), Coppice, (closed on 24th February 1986), Saxondale Hospital (in the process of being closed at the time of writing), St. Francis Hospital, and several beds contained in the new teaching hospital at the Queen's Medical Centre, Nottingham University Hospital.Google Scholar
This is compared with 48 out of 125, or 38.4 percent for the 15–24 age group. Clearly, the elderly group differs in this respect. An χ2-test shows there is significant difference with the 65 + age group contributing most to the χ2 value. Indeed, taking this overall, the 65 + age group with 268 out of 650 (or 41.2 percent) account for most of the non-contacts. The same point can be made in a slightly different way when the age groups with six or more contacts are compared. The 65+ age group has only 27 patients out of 571 with six or more contacts (or 4.7 percent).Google Scholar
Tyrer, P. Turner, R. (1988), “Integrating Hospital and Community Psychiatric Services Leads to Reduced Inpatient Beds.” (In preparation.)Google Scholar
Nottingham Psychiatric Case Register, (1987) Statistical Bulletin No. 2 Series 1987, mimeo.Google Scholar
Joseph, Sir K. (1971), “Hospital Services for the Mentally Ill,” H.M.S.O.Google Scholar
We are currently conducting a study of homelessness and mental patients and our preliminary findings suggest that 18 percent of mental patients feature in the homelessness figures. See Mounser, P. Bean, P.T. (1988), “Homelessness and the Mentally Disordered,” in press.Google Scholar
See Bean, P.T. (1980), Compulsory Admissions to Mental Hospitals, John Wiley and Sons, for a discussion on the use of controls within the Mental Hospital.Google Scholar
In 1980 there were 52 patients classified as first admissions who entered hospital compulsorily out of a total of 365 (or 14 percent). In 1985 the number had dropped to 48 out of 278 (or 17 percent). For subsequent admissions there were 50 formal patients out of 338 in 1980 (or 15 percent) and 82 out of 364 in 1985. This data was taken from the Nottingham Case Register, op. cit.Google Scholar
Royal College of Psychiatrists (1987), “Compulsory Treatment in the Community,” mimeo.Google Scholar
Mental Health Act Commission (1987), “Compulsory Treatment in the Community: A discussion paper.”Google Scholar
See Bean, P.T. (1987), Mental Disorder and Legal Control, Cambridge University Press.Google Scholar
Cohen, S. (1985), Visions of Social Control, Polity Press.Google Scholar
Ibid. The term ‘wider stronger nets’ is taken from Austin, J. Krisberg, B. (1981) “Wider Stronger and Different Nets: The Dialectics of Criminal Justice Reform,” Journal of Research in Crime and Delinquency, (Jan) pp. 165–169.Google Scholar
Quoted in Cohen, , supra note 1, 221.Google Scholar
Brown, P. (1985), The Transfer of Care: Psychiatric Deinstitutionalization and Its Aftermath, Routledge, New York.Google Scholar
Cohen, , supra note 1, 87.Google Scholar
So too did new laws in Britain and America, which to some psychiatrists had the impertinence to monitor what psychiatrists did, e.g. to introduce the Mental Health Commission in the U.K. and the Joint Committee on the Accreditation of Hospitals in the U.S.A. and to judge how fair and effective in-patient hospital care turns out to be.Google Scholar