EDITOR- I take Dr Sikdar's point that the situation on acute wards may be different from that on long-stay wards, as studied by the TAPS project. We did find differences when we looked at this issue in Sheffield.1,2 The argument about the failure of community care has been fuelled by the number of homeless mentally ill, but this problem seems to be more related to housing policy that psychiatric dehospitalisation.3 There is little argument that the failures of community have been caused by underfunding, inadequate care and poor management, but the policy has brought many benefits.4 It is important to recognise the reactionary influences which have brought the government to its current position, not least many psychiatrists themselves, who are opposed to community care, because of their loss of power in the traditional psychiatric hospital.5 Psychiatrists' attitudes to community care need to change before it can be said to have been properly implemented. The review of the Mental Health Act should provide further safeguards against the potential abuse of medical power, reinforcing the motivation for the 1983 reforms 6
1. Double DB & Wong TI. What's happened to patients from longstay psychiatric wards? Psychiatric Bulletin 1991; 15: 735-6 http://www.uea.ac.uk/~wp276/outcome2.htm
2. Double DB, Macpherson R & Wong TI. Tracing patients from acute psychiatric wards. Journal of the Royal Society of Medicine 1993; 86: 533-4 http://www.uea.ac.uk/~wp276/outcome3.htm
Rapid Response:
Re: Care in the community
EDITOR- I take Dr Sikdar's point that the situation on acute wards may be different from that on long-stay wards, as studied by the TAPS project. We did find differences when we looked at this issue in Sheffield.1,2 The argument about the failure of community care has been fuelled by the number of homeless mentally ill, but this problem seems to be more related to housing policy that psychiatric dehospitalisation.3 There is little argument that the failures of community have been caused by underfunding, inadequate care and poor management, but the policy has brought many benefits.4 It is important to recognise the reactionary influences which have brought the government to its current position, not least many psychiatrists themselves, who are opposed to community care, because of their loss of power in the traditional psychiatric hospital.5 Psychiatrists' attitudes to community care need to change before it can be said to have been properly implemented. The review of the Mental Health Act should provide further safeguards against the potential abuse of medical power, reinforcing the motivation for the 1983 reforms 6
1. Double DB & Wong TI. What's happened to patients from longstay psychiatric wards? Psychiatric Bulletin 1991; 15: 735-6 http://www.uea.ac.uk/~wp276/outcome2.htm
2. Double DB, Macpherson R & Wong TI. Tracing patients from acute psychiatric wards. Journal of the Royal Society of Medicine 1993; 86: 533-4 http://www.uea.ac.uk/~wp276/outcome3.htm
3. Double DB. Homelessness and mental illness. The Mental Health Policy Website. http://www.uea.ac.uk/~wp276/homeless.htm
4. Double DB. In what sense has community care failed? eBMJhttp://www.bmj.com/cgi/eletters/318/7175/3#EL11
5. Double DB. Have psychiatrists failed community care? eBMJhttp://www.bmj.com/cgi/eletters/318/7175/3#EL8
6. Critical Psychiatry Network. Response to the consultation document Reform of the Mental Health Act. http://www.critpsynet.freeuk.com/ResponseReform.htm
Competing interests: No competing interests