Elizabeth Buie in Mental Health Week discusses the plight of
discharged patients and the dangers they can present to themselves and
others.
THE mentally ill tend to be the ''Cinderellas'' of the minority groups
-- unfashionable, unloved, sometimes unwashed, and usually ignored. But
this is Mental Health Week, so perhaps they will have a chance to catch
the nation's attention.
Certainly, the more spectacular cases have made headlines in recent
months -- Ben Silcock who died in the lions' den in the zoo; Christopher
Clunis who killed Jonathon Zito at random in a London tube station;
Michael Buchanan who mugged and kicked unconscious 70-year-old Frederick
Graver.
These cases, all in England, prompted the campaigner Marjorie Wallace,
chief executive of SANE, a leading mental health charity, to call for an
immediate halt to the mental health hospital closure programme which is
part of the Government's Care in the Community policy.
''There is far too much pressure on psychiatrists to discharge people
into the community before they are stabilised,'' said Ms Wallace.
Health Secretary Virginia Bottomley has accepted that better
safeguards are needed for mentally ill people who have been discharged
into the community and is currently awaiting the conclusions of an
internal review into the supervision of such people.
In Scotland, the Community Care programme has only been implemented in
the last year.
The Scottish Association for Mental Health is adopting a cautious
approach, saying it is still too early to judge whether people are being
discharged from psychiatric institutions without sufficient support. It
is concerned, however, that the Government has refused to ring-fence the
savings it is making from the closure of psychiatric hospitals to plough
them back into community care.
But even if it is too early to tell how well the current programme is
succeeding, there are claims that patients who were discharged into the
community before the current legislation was implemented are not
receiving the kind of support and follow-up they need.
And what of their neighbours, who may have problems of their own, and
may have no experience in dealing with a person with mental health
problems who has stopped taking his or her medication?
Joe (not his real name) lives in a council flat on the outskirts of
Glasgow. He is 39 years of age, a former sales representative, who is in
very poor physical health. Joe is waiting for a triple heart by-pass
operation, and if that succeeds, major bowel surgery. He is suffering
from coronary heart disease, angina, chronic bronchitis, asthma, eczema,
and ulcerative colitis. His GP has told him to avoid stress at all
costs. He had one heart attack earlier this year and could have another
at any time.
A year ago, a new neighbour, Phil (not his real name) moved in to the
flat next door to him. Phil, aged 35, had been discharged from Woodilee
Hospital where he had been treated for a number of years for mild
schizophrenia.
Recently Joe contacted The Herald when he had reached the end of his
tether. He had contacted the police, doctors, and social workers, and
no-one seemed to be able to help, he said. The problem appeared to be
that when Phil stopped taking his medication he would become paranoid
and disturbed. He would accuse his neighbours, Joe in particular, of
breaking into his house and stealing the tops from his lemonade bottles,
his Sellotape, and other such things. Or he would complain of people
tapping on his walls and banging on his doors in the middle of the night
-- at which point he would come round to Joe's door, or just shout
through the wall at him, accusing him of the deed.
''I did invite him in for a cup of tea, just to calm him down. He
would jump up and down at the door. The noise, irregularity and
persistence of it are the most stressful things,'' said Joe.
''He doesn't take his medication -- he has admitted this. The point is
that when he does take it, he is OK. I don't wish the guy any harm. But
judging from what he has said himself, he has not been followed up,'' he
added.
''The principle of being in the community is good, but if the person
is not followed up, it is not fair on the people with the illnesses and
not fair on the community,'' said Joe.
Police covering this particular area confirm they have been called to
deal with incidents involving Phil, but as he was committing no criminal
offence at the time, were powerless to do much other than try and calm
him down. They say that in such circumstances, they would normally alert
the social services. They also say that in the last few days, Phil has
been readmitted to hospital. Who can tell whether he did in fact receive
too little support, and if kept on medication, might still be leading a
relatively normal life in the community?
Ms Lynn Welsh, the Legal Services Agency's specialist solicitor in
mental health law, points out that while community care policy operates
in the same way in Scotland and England, the mental health legislation
applying to the two countries differs. Scotland, unlike England,
operates a ''long leash'' policy, which means that a person detained
under the Mental Health (Scotland) Act can be allowed to return home or
into the community under a compulsory order, which would probably
specify that he or she must continue to take medication. But if the
person's condition deteriorated, he or she could immediately be detained
again in hospital. No such compulsory order exists in England -- and it
is such a power that some have advocated in the light of some recent
tragic cases.
Lynn Welsh also believes that such is the pressure upon resources that
some people who have been discharged are not being seen by a doctor for
three months. ''By then, they may have stopped their medication and have
been dragged back into hospital,'' she said.
Some hospital boards are pressurising social work departments into
finding accommodation for patients when suitable accommodation is not
yet available, she claims.
''Some people may need sheltered accommodation but find they are
offered homeless accommodation, which is massively unsuitable for
someone in a vulnerable position,'' she adds.
In cases such as Joe's and Phil's, all she can advise Joe to do is ask
the social work department to carry out a social work assessment of his
own needs.
Andrew Reid, from the social work department, suggests that in an
ideal world, the well neighbour could ask the mentally unwell neighbour
if he may call in his doctor or a psychiatric nursing visitor. However,
he recognises that we do not live in an ideal world, and recommends
contacting the local health centre to send a psychiatric nursing visitor
or the duty social worker.
He too points to the difference between England and Scotland in the
application of mental health legislation, but feels the core issue is
the same: ''How bad do things have to get before we enact compulsory
measures?''
But let us give Ms Claire Walker, a spokeswoman for SAMH, the final
word: ''At present, 95% of people with mental health problems are in the
community and 5% are in hospital. But 95% of the resources are spent on
the 5% in hospital.''
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