Back to Bedlam

The Thatcher government’s decision to shut down NHS mental hospitals and rely on so-called ‘community care’ for the mentally ill has condemned many of them to a life of begging and petty crime, which often lands them in prison where no proper provision is made for them, as Angela Clifford explains.

It has recently been reported that Brixton Prison in London has become a dumping ground for mentally ill patients. Thus society’s attitude to the mentally ill has gone full circle – back to the policies which produced ‘Bedlam’, as the institution of a bygone era was called, where the mentally ill were locked away in awful conditions for an indefinite time.

All that was changed by social reform, but the progressive developments in mental health treatment have been negated by an unholy alliance of trendy Leftism and Thatcherism.

‘Advanced’, ‘progressive’, medicine produced the theory that mentally ill people are oppressed by putting them in mental institutions. This view was seized on by Thatcherites looking for cuts to make in the public services. The ideological Left and the ideological Right combined in a policy of shutting down mental hospitals, and replacing them with so-called “community care“.

‘Community care’ means transferring patients from a national, planned health care system to whatever provision local authorities may care to make for them. It must be remembered that there is no overall, socialised provision of care in the personal social services, as there is for health. This is a legacy of the Poor Law, which has never been reformed in that respect.

As a result, local authorities provide such services as they can, or wish to, afford. And places like London, where there is a concentration of problems, have undue financial pressures placed on them. ‘Community care’ might be appropriate for a small minority of cases, or as a transitional stage for people who are ready to return to society. It is quite inappropriate for most mental patients.

Eoin Harris, the Irish publicist, has described his own period of mental illness, and identified the need of many for a refuge from society. As he says, the mental hospital also provides a community – and one that is better able to understand the problems of mental illness. He goes so far as to say that the worst mental hospital provides a better environment for a return to health than isolation in the community at large.

In fact, “community care” has been little more than the ejection of mental patients from hospitals, with a token amount of ‘care’ from the ‘community’. And what else could it be ? After all, the costs of providing comprehensive ‘care’ for individuals in the community would be prohibitive.

I was struck in Belfast a few years ago that a new type of beggar had appeared on the streets. On enquiring about them, I learned that they were patients ejected from mental care, who were at a loose end. They spent some hours in a Salvation Army hostel, but when this was closed, they wandered around begging.

This type of begging has also appeared in other large centres, such as London. Some, apparently, engage in petty crime and land up in prison. A report recently explained:

“Brixton is now regarded as a ‘dumping ground’ for mentally ill people. Many inmates were discharged from mental institutions under the government’s controversial ‘care in the community’ scheme and were charged with relatively minor offences, such as shoplifting. They were sent to Brixton because there were no longer places for them in London’s declining number of psychiatric hospitals.

“Once inside Brixton, they are transferred to F wing, the prison’s hospital unit, which is known to staff and inmates alike as ‘Fraggle Rock’. Former inmates have described F wing as ‘bedlam’. Prisoners scream and shout almost all day. Despite those judged ‘at risk’ of attempting to commit suicide being checked at least every 15 minutes, many have nonetheless been able to take their own lives …

Mr Shaw (director of the Prison Reform Trust – A.C.) says mentally-ill inmates receive poor treatment from staff who often have little medical – and rarely psychiatric – training. ‘The treatment of the 200 prisoners in F wing is the biggest single scandal anywhere in the British prison system today,’ he said. ‘Many are in a state of acute psychiatric distress, yet the treatment they receive is utterly at variance with approved standards for the treatment of mentally ill people.’ Treatment was far below standards in the National Health Service, he said” (Denis Campbell, Irish Times, July 9, 1991).

This report appeared amidst commentary on conditions of IRA prisoners in British jails in the context of the Brixton break-out. Sometimes Irish journalists can see British conditions more clearly, from their outside vantage point. Instead of the mentally ill being properly cared for in NHS hospitals, they end up in prison or on the streets – that is the real content of ‘community care’.

It seems to me that a far better option would have been to give those mentally ill who could benefit by it more responsibility for their own lives within mental hospitals (such as by doing their own shopping, cooking, cleaning arranging their own entertainment, etc).

The question now is whether Labour is ready to repudiate Thatcherism in the medical services and to stand for the provision of sufficient places in mental hospitals for those who need them.

 

This article appeared in September 1991, in Issue 25 of Labour and Trade Union Review, now Labour Affairs.  You can find more from the era at https://labouraffairsmagazine.com/very-old-issues-images/.