The statistics on mental hospital closures given by Professor Leff (Reference Leff2001) will surprise not only lay people. I had no idea that hardly any mental hospital beds remain. As someone whose career in psychiatry began in a 2300-bed hospital in 1957, I find it difficult to believe that this has actually happened.

I have no reason to doubt the sincerity of those people, medical and lay, who have enthusiastically advocated community care over the years. I am sure that they did not envisage that all the patients in the mental hospitals would eventually be discharged. Nor could they be blamed for failing to realise that the politicians, who hold the purse strings, would see community care not as an advance in treatment, but rather as a glorious excuse to save money.

One can see how the process developed: it must soon have appeared that discharging only some of the patients would not be enough, since, if community care failed, there would be demands for readmission. The only logical course was, therefore, to discharge all the patients, get rid of all the staff, demolish the hospitals and, as an additional bonus, sell off the land to property developers.

Unfortunately for the politicians, Griffiths reported that good community care would be very expensive, not cheap as they had hoped. They were faced with a new dilemma — what was the point in saving a lot of money by demolishing the hospitals if it all had to be redeployed for community care? The solution was obvious — restrict the amount of funding for community care!

It seems that, from now on, we will have the worst of all possible worlds — virtually no mental hospitals and poorly funded community care.