The crisis in Britain's mental health care
24 July 1999
The Blair government's proposals to lock away those deemed to be suffering from a Severe Personality Disorder serve to divert attention from the real problem highlighted by incidents such as the Russell murders—the crisis in Britain's mental health care.
In the late 1980s, the then Tory government established an inquiry into mental health care, following the 1984 murder of social worker Isabel Schwarz by a former client. Led by Sir Roy Griffiths, it resulted in the National Health Service and Community Care Act of 1990. The new Act was presented as a progressive, reforming approach to mental health care, that would build upon new drug treatments and end the use of "antiquated" asylums. Individuals would now receive "care in the community", supposedly through a network of supervisors.
Its primary motive, however, was financial. Between 1987-88 and 1994-95 the average daily number of long stay beds available in hospitals for the mentally ill fell by half—from 38,984 to 18,644. The number of 24-hour nursed beds in residential care was cut by one-third over the same period whilst the proportion of the average hospital budget spent on mental health fell from 14.4 percent to 12 percent.
The mentally ill were left to rely on local health and social services departments, themselves facing cut backs and staff shortages. At the same time, the emphasis on drug treatment—caused to no small degree by the overbearing influence of the pharmaceutical companies—led to a decline in the availability of other forms of rehabilitation and therapy. People can now wait months just to be referred for psychiatric assessment, as counselling services have become marginalised, in favour of drug treatments such as Prozac.
All this has taken place against a background in which the rapid economic and social changes over the last decade have created a climate of insecurity, impacting particularly upon the most vulnerable sections of society. One in 10 people in Britain now experience serious mental health problems, and one in four families are affected. Most alarmingly, incidents of mental ill health, particularly depression, are increasing amongst children.
The mentally ill have been the primary victims of these changes. The National Schizophrenia Fellowship (NSF) reports that vulnerable mentally ill people are being housed in unsupported bed-and-breakfast accommodation, often miles from their care workers. Many can end up on the streets, or in homeless hostels, where there is no control over their medication. A disproportionate number are imprisoned for petty offences. In addition, changes to welfare entitlements have exacerbated the stresses facing many mentally ill patients. The NSF reported a flood of phone calls from distressed patients following the government's announcement last year that it would cut invalidity benefits.
One in seven people with serious mental illness commit suicide. In 1996-97, nearly 500 such individuals took their own lives. The NSF also pointed out that the hysterical media campaigns had only increased the stigma attached to mental illness. Following the kidnapping, torture and murder of teenager Angela Peace (a diagnosed schizophrenic) by five youths, it had issued a press statement calling on the "media to act responsibly and to present mental issues in a fair and balanced manner".
At the time of the government's review, mental health groups and campaigners insisted that the number one priority was to guarantee the legal right of all to adequate care and treatment. But in keeping with its stance on all issues of social policy, the Blair government has effectively dismissed such demands in favour of more punitive measures.