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Success of community care?

Published online by Cambridge University Press:  02 January 2018

M. P. I. Weller*
Affiliation:
Psychiatry Department, School of Social Sciences, Middlesex University Queensway, Enfield EN3 4SA, UK
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2003 

There is debate regarding the success or otherwise of community care. The evidence deriving from the closure of Friern Hospital on which the Team for the Assessment of Psychiatric Services project is based, discussed by Leff (Reference Leff2001), cannot be generalised because, in contrast to typical hospital closures, in the region of £100 million was allocated to ensure the ‘success’ of the project. Despite this expenditure, the following points should be considered.

At the time of the closure of Friern Hospital an internal audit found that only 14 long-stay patients were there by compulsion and 11 of those were under court orders (Reference WellerWeller, 1989).

After closure, high wire netting was erected and 24-hour guard-dog patrols were instituted because of attempted returns by patients to the hospital.

Many of the patients offered ‘a home for life’ were subsequently moved.

Many have become ‘revolving-door’ patients.

The hospital building, of listed architectural merit (but which drew inexplicable opprobrium at the time), and spacious grounds are now luxury flats, and a £400 million deal has been struck for many more on other hospital sites (The Times, 12 September 2002: p. 3).

Twenty patients committed suicide in the first year after closure (further details available from the author upon request). This figure stands in contrast to the findings of Powell et al (Reference Powell, Geddes and Hawton2000), who showed that even within the high-risk group of inpatients, 100 patients would need to be detained unnecessarily in order to prevent one suicide.

Footnotes

EDITED BY KHALIDA ISMAIL

Declaration of interest

Grant from the Regional Health Authority and the National Schizophrenia Fellowship to compile the suicide statistics.

References

Leff, J. (2001) Why is care in the community perceived as a failure? British Journal of Psychiatry, 179, 381383.Google Scholar
Powell, J., Geddes, J., Hawton, K., et al (2000) Suicide in psychiatric hospital in-patients. Risk factors and their predictive power. British Journal of Psychiatry, 176, 266272.Google Scholar
Weller, M. P. I. (1989) Mental illness – who cares? Nature 399, 249252.Google Scholar
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