THE BLINKERED determination of ministers and NHS chiefs to push through massive bed closures in London's psychiatric hospitals has opened the door to disaster.
The publication of the inquiry report on the tragic case of discharged schizophrenic Christopher Clunis, who stabbed a man to death on a tube platform in December 1992, revealed not only a catalogue of failure by five different agencies, but a complete absence of any overall control or chain of responsibility to ensure that community care can work.
No matter how many highsounding 'guidelines' may be published in response to disasters, the system that has emerged is a total shambles.
There is no individual or body with the authority to compel cash- strapped local health Trusts, purchasing authorities, social services and relevant voluntary groups to sit down and plan out a comprehensive service.
Instead each of them tends to seek to balance its books at the expense of the other, leaving the police to tackle the problems that can arise when a potentially violent patient is left without care or support.
While the holes in districtlevel provision are big enough, there is no Londonwide strategy for community care: instead councils throughout the capital have been left without the cash to create a proper infrastructure of day care and other community-based services for people with mental illness.
The government in 1988 specifically rejected recommendations from Mrs Thatcher's advisor Sir Roy Griffiths that there should be a minister for Community Dodging blame But Bottomley has also refused to accept responsibility for the collapse of the fragmented and under-resourced system her government has put in place, attempting to shuffle off the blame onto under-funded boroughs.
The inquiry report called for an increase in provision of acute mental illness beds, of which there is a dire and chronic shortage in inner London, and more secure units for the treatment of severely disturbed patients.
Even the Tomlinson Report, proposing drastic cuts in medical and surgical hospital beds, called 18 months ago for an urgent review of the adequacy of provision of acute psychiatric admission beds. This has been ignored.
Instead all Bottomley now offers is another £10m for provision of community-based services.
London Health Emergency has consistently exposed the lack of proper community-based psychiatric services to replace the thousands of mental health beds closed since 1984, and warned of the pressure on acute mental illness beds in the capital.
Information Director John Lister called for an immediate injection of cash to tackle the problem. He said:
"It is a scandal that it takes a tragedy like this to gain attention for the neglect of mental health services, and the collapse of the so-called community care policy. Psychiatric wards all over inner London are bursting at the seams, with many showing beds more than 100% occupied.
"Even now the government is throwing £6 million into subsidising new voluntary sector schemes designed to close down 150 more mental health beds in London, while as this report shows there are already too few psychiatric beds to meet the needs of desperately ill patients. Immediate action is needed to stop further suffering."
SOCIALIST OUTLOOK No. 59, 26 March 1994, Page 6 UNISON Local Government Conference DEFEND STRIKE DEFEND SAND nS AND VICES