Care in the Community

In Dr Crippen’s Blog today, he reminded us of his account of Emma, which is not dissimilar to the experience of many Schizophrenics suffering under the current “Care” approach. He said then:

“The care of schizophrenics in the UK is a disgrace. It is a matter of national shame. The majority of psychiatrists take no interest and pretend that the GPs are looking after them. The majority of GPs take no interest and pretend the psychiatrists are looking after them. The few who do try to take an interest – and it is one of Dr Crippen’s areas of interest - get no support. Most of the work falls upon the community psychiatric nurses and there are not enough of them.”

From the Chapter called The Last Cook in The Cockroach Catcher:

“......We were at a loss as to what was going on. We had never seen father but we knew he had a diagnosis of Schizophrenia and was on Modecate injection. Mother had always insisted that he was so ‘out of it’ that there would not be any point in the unit involving him. We did have reports from his day-hospital social worker and we left it at that.

I nodded.

‘But I cannot leave him. I have nowhere to go and I shall not get enough benefit money if I am divorced from him. He now goes to the day hospital. Fridays he gets drunk and beats me up. It is like a routine. I try not to get hurt and hide it from the girls. If I walk out, he will find me even if I have somewhere to go. I shall still get beaten up. Now at least I know when it will happen and I can live with that.’

I suggested that I should speak to him but she looked terrified.

She felt he might even kill her if I did and last time he threw a chair at a male nurse who tried to say something.

She was probably right. We often had no idea what people and particularly women put up with. It would be too easy for us to bulldoze in. We had to think twice before intervening unless we had something better to offer. His Schizophrenia diagnosis allowed for a higher level of benefit she would not otherwise get. Who would she meet up with next? Another violent man most likely.

Was it such a cop-out on my part?

Maybe it was, but in a strange way the girls stopped soiling after that one meeting I had with mum. The case left me with some unease - unease not just about what I did or did not do but about keeping patients in the community. Three other lives were affected here and who knows, one day he might go too far......”

Across the Channel, France has possibly the highest number of Psychiatrists per capita anywhere in the world and its Health Care system has been consistently nominated as one of the world’s best. France still keep most of their Mental Hospitals complete with Medical Superintendents, none of this business of having CEO from the non health related industry. A recent report in ABC News hailed: “French Health Care: C'est Magnifique!”

We need to bring the heart back to medicine and psychiatry in particular.

In an article in European Archives of Psychiatry and Clinical Neuroscience in March 2007:

“Hospital-based care has still an overwhelming importance, and is associated with a marked under-development of community services and lack of sheltered housing for the most disabled patients.”

Please learn from us. Do not underestimate the value of hospital-based care for those mental patients who need it. Unfortunately for us, it might be too late as the new generation of psychiatrists have no idea what mental hospitals are like or could be like and many will have no chance of seeing one. I once visited one such hospital in Paris and I must admit I could see great possibilities for better care for mental patients. Homelessness and random violence will remain the public's top concerns. Unfortunately it is also the public's perception of the outcome of Care in the Community.