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Community Care and the Difficult and Offender Patient

Published online by Cambridge University Press:  02 January 2018

T. D. Scannell
T. D. Scannell*
Affiliation:
St George's Hospital, London; in Adolescent Psychiatry, Department of Psychological Medicine, William Harvey House, St Bartholomew's Hospital, West Smithfleld, London EC1A 7BE
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Extract

Concern has been growing about a cyclical pattern or ‘periodicity’ in mental health care over the past 300 years, in which large-scale policy decisions have been made, and then reversed, paying little attention to the particular needs of differing patient groups. Turner (1985) drew attention to the reckless course followed by psychiatry, and how the “discipline that has lost its way” (Lancet, 1985) may have done so owing to a poor grasp of its past history. In the movement towards community care, ‘difficult’ or the so-called ‘unrewarding’ (to use Scott's (1970) term) patients are a particularly vulnerable group (Aviram & Segal, 1973; Bachrach, 1980). Increasingly, community services are compelled to cater for less disturbed patients through being selective about whom they will accept. To a degree, forensic services on both sides of the Atlantic have partially filled the gap so created in service provision. For this and other reasons, it is difficult to make a general statement about the effectiveness of deinstitutionalisation and community care. To be more specific, there are basic conceptual difficulties in defining continuity of care and identifying subgroups for which it has different implications (Bachrach, 1981), and there are major methodological difficulties impeding an analysis of such a diffuse and fragmented provision. Scull's (1984) description of the overnight abolition of state facilities for juvenile offenders in Massachusetts in the US between 1969 and 1973 points to the impossibility of making a comparison ‘before and after’, when so much dissolution and decentralisation of services has occurred (see also Jones, 1982). A few model alternatives were described soon after the closures, and Bachrach (1980) has written about the dangers of generalising from model programmes, highlighting the differences between demonstration efforts and reality. It is proposed here that the difficult and offender population might act as a ‘litmus paper’ for the efficiency, or otherwise, of community care in general.

Type
Comment
Information
The British Journal of Psychiatry , Volume 154 , Issue 5 , May 1989 , pp. 615 - 619
Copyright
Copyright © Royal College of Psychiatrists, 1989 

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References

Aviram, U. & Segal, R. P. (1973) Exclusion of the mentally ill. Archives of General Psychiatry, 29, 126–131.Google Scholar
Bachrach, L. L. (1980) Overview: model programmes for chronic mental patients. American Journal of Psychiatry, 137, 1023–1031.Google ScholarPubMed
Bachrach, L. L. (1981) Continuity of care for chronic mental patients: a conceptual analysis. American Journal of Psychiatry, 138, 1449–1456.Google ScholarPubMed
Bentham, J. (1843) The Works of Jeremy Bentham. (ed. Bowring, I. V.), pp. 172–173.Google Scholar
Bicknell, J. (1985) The mental handicap service – modern concepts of care. In Caring for Mentally Handicapped in the Community (eds Sines, D. & Bicknell, J.). London: Harper & Row.Google Scholar
Bion, W. R. (1961) Experiences in Groups. London: Tavistock.Google Scholar
Bluglass, R. (1978) Regional secure units and interim security for psychiatric patients. British Medical Journal, i, 489–493.Google Scholar
Bowden, P. (1977) The current management of the mentally abnormal offender. Proceedings of the Royal Society of Medicine, 70, 881–884.Google Scholar
Brickner, P. W., Scanlan, B. C., Conanan, B., et al (1986) Homeless persons and health care. Annals of Internal Medicine, 104, 405–409.Google Scholar
Brown, G. W., Birley, J. L. T. & Wing, J. K. (1972) Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121, 241–258.Google Scholar
Caton, C. L. M. (1981) The new chronic patient and the system of community care. Hospital Community Psychiatry, 32, 475–478.Google ScholarPubMed
David, A. S. (1988) On the street in America. British Medical Journal, 296, 1016.Google Scholar
Deutsch, A. (1949) The Mentally Ill in America. New York: Columbia University Press.Google Scholar
Department of Health and Social Security (1974) Report on Security in NHS Hospitals (Glancy report). London: HMSO.Google Scholar
Department of Health and Social Security & Home Office (1975) Report of the Committee on Mentally Abnormal Offenders (Butler report). London: HMSO.Google Scholar
Dunham, H. (1965) Community psychiatry: the newest therapeutic bandwagon. Archives of General Psychiatry, 12, 303–313.CrossRefGoogle ScholarPubMed
Foucault, M. (1961) Madness and Civilisation. London: Penguin Books.Google Scholar
Friedman, R. (1985) Resistance to alternatives to hospitalisation. Psychiatric Clinics of North America, 8, 471–482.Google Scholar
Grad, J. & Sainsbury, P. (1968) The effects that patients have on their families in a community care and control service – a 2 year follow up. British Journal of Psychiatry, 114, 265–278.Google Scholar
Grob, G. (1966) The State and the Mentally Ill. Chapel Hill: University of North Carolina Press.Google Scholar
Grob, G. (1973) Mental Institutions in America: Social Policy to 1875. New York: Free Press.Google Scholar
Hansard, (1984) House of Lords. Debate on mentally ill offenders in prison. House of Lords official report. Hansard, 12 December, Cols 351–380.Google Scholar
Home Office & Department of Health and Social Security (1973) Report on the Review of Procedures for the Discharge and Supervision of Psychiatric Patients subject to Special Restrictions (Aarvold report), cmnd 5191. London: HMSO.Google Scholar
Hughes, R. (1987) The Fatal Shore. London: Collins Harvill.Google Scholar
Jones, D. (1985) Commentary: deinstitutionalisation of mental health services in South Australia – out of the frying pan into the fire? Community Health Studies, 9, 62–68.CrossRefGoogle Scholar
Jones, K. (1972) A History of the Mental Health Services. London: Routledge and Paul.Google Scholar
Jones, K. (1982) Scull's dilemma. British Journal of Psychiatry, 141, 221–226.Google Scholar
Jones, M. (1952) Social Psychiatry: a Study of Therapeutic Communities. London: Tavistock.Google Scholar
Kushlick, A. (1965) Community services for the mentally subnormal. Proceedings of the Royal Society of Medicine, 58, 373–379.Google Scholar
Lamb, H. R. (1982) Young adult chronic patients: the new drifters. Hospital Community Psychiatry, 44, 465–468.Google Scholar
Lancet (1985) Editorial. Psychiatry – a discipline that has lost its way. Lancet, i, 731–732.Google Scholar
Lancet (1986) Editorial. Secure accommodation in psychiatric hospitals. Lancet, ii, 24–25.Google Scholar
Littlewood, R. & Lipsedge, M. (1988) Psychiatric illness among British Afro-Caribbeans. British Medical Journal, 296, 950–951.Google Scholar
Martin, J. P. (1984) Hospitals in Trouble, Oxford: Black well.Google ScholarPubMed
McGovern, D. & Cope, R. (1987) The compulsory detention of males of different ethnic groups, with special reference to offender patients. British Journal of Psychiatry, 150, 505–512.Google Scholar
Menzies, I. (1960) A case study in the functioning of social systems as a defense against anxiety. Human Relations, 13, 95–121.CrossRefGoogle Scholar
Miles, A. (1981) The Mentally Ill in Contemporary Society. Oxford: Martin Robertson.Google Scholar
NACRO (1988) Report of the NACRO Working Group on Sentences Made under Section 53 of the 1933 Children and Young Person's Act (Grave Crimes, Grave Doubts). London: NACRO.Google Scholar
Orr, J. (1978) The imprisonment of mentally disordered offenders. British Journal of Psychiatry, 133, 194–199.CrossRefGoogle ScholarPubMed
Penrose, L. S. (1939) Mental disease and crime: outline of comparative study of European statistics. British Journal of Medical Psychology, 18, 1–15.Google Scholar
Powell, E. (1961) Emerging Patterns for Mental Health Services and the Public. Report of the Annual Conference of the National Association for Mental Health, 5–10. London: NAMH.Google Scholar
Rosen, G. (1968) Madness in Society. New York: Harper and Row.Google Scholar
Sands, R. G. (1984) Correlates of success and lack of success in deinstitutionalisation. Community Mental Health Journal, 20, 223–235.Google Scholar
Sarteschi, P., Cassano, G. B., Mauri, M., et al (1985) Medical and social consequences of the Italian psychiatric care act. In Psychiatry, Human Rights and the Law (eds Roth, M. & Bluglass, R.). Cambridge: Cambridge University Press.Google Scholar
Scannell, T. D. (1986) Secure accommodation in psychiatric hospitals (letter). Lancet, i, 347.Google Scholar
Schmidt, L. J., Reinhadt, A. M., Kane, R. L., et al (1977) The mentally ill in nursing homes, new back wards in the community. Archives of General Psychiatry, 34, 687–691.Google Scholar
Scott, P. D. (1970) Punishment or treatment: prison or hospital. British Medical Journal, ii, 167.Google Scholar
Scull, A. (1979) Museums of Madness. London: Allen Lane; New York: St Martin Press.Google Scholar
Scull, A. (1984) Decarceration – Community Treatment and the Deviant – a Radical View. Cambridge: Polity Press.Google Scholar
Segal, S. P. & Aviram, U. (1978) The Mentally Ill in Community Based Sheltered Care. New York: John Wiley & Sons.Google Scholar
Showalter, E. (1987) The Female Malady: Women, Madness and English Culture 1830–1980. London: Vitago.Google Scholar
Snowden, P. R. (1987) Regional structure units: arriving but under threat. British Medical Journal, 294, 1310–1311.CrossRefGoogle Scholar
Steadman, H. J. (1985) Prediction in the system level. In Dangerousness (eds Webster, C. D., Ben-Aron, M. H. & Hucker, S. J.). Cambridge: Cambridge University Press.Google Scholar
Stone, A. A. (1985) The social and medical consequences of recent legal reforms of mental health law in the U.S.A; the criminalisation of mental disorder. In Psychiatry, Human Rights and the Law (eds Roth, M. & Bluglass, R.). Cambridge: Cambridge University Press.Google Scholar
Teplin, L. A. (1983) The criminalisation of the mentally ill: speculation in search of data. Psychological Bulletin, 94, 54–67.Google Scholar
Tizard, J. & Grad, J. C. (1961) The Mentally Handicapped and their families. Maudsley Monographs 7, London: Oxford University Press.Google Scholar
Torrey, E. F. & Wolfe, S. M. (1986) Care of the Seriously Mentally Ill: a Rating of State Programs. Washington, DC: Public Citizen Health Research Group.Google Scholar
Turner, T. H. (1985) The past of psychiatry – why build asylums? Lancet, ii, 709–711.Google Scholar
US General Accounting Office (1977) Returning the Mentally Disabled to the Community: Government Needs to Do More. Washington, DC: US Government Printing Office.Google Scholar
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