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.''