FRANK Dobson stirred a hornet's nest of media interest when he hinted at a chronic mental illness. But change at all.
Newspapers, TV and radio stations which have only ever reported on mental health services when things went wrong and ended in murder, insisted that Dobson had "scrapped" the policy of community care, which has run into increasing disrenute.
They seized upon the frightening figure that a murder every two weeks is carried out by a mental health sufferer - downplaying the even more alarming fact that 40 times more mental patients - 1,000 a year - commit suicide, and welcomed the idea that more of these people would be effectively locked away.
In fact, Dobson's statement was confused and mutually contradictory: he appeared to be echoing the view of his predecessor Stephen Dorrell that there is a need for extra facilities, 24-hour nursed accommodation, to care for those who are seriously ill. This same message has been consistently relayed by anyone who has seriously examined mental health care in the last 13 years.
Early in 1985 the Commons Social Services Committee published a damning critique of the progress so far on community care, insisting that:
"The stage has now been reached where the rhetoric of comDobson - echoing Dorrell munity care has to be matched by action, and where the public are understandably anxious about the consecuences.
"...The pace of removal of hospital facilities for mental illness has far outrun the provision of services in the community to replace them. It is only now that people are waking up to the legacy of a policy of hospital rundown which began over 20 years ago.
...We do not wish to slow down the exodus from mental illness... hospitals for its own sake. But we do look to see the same degree of Ministerial pressure, and the provision of necessary resources, devoted to the creation of alternative services. Any fool can close a long-stay hospital: it takes more time and trouble to do it properly and compassionately".
Following on the heels of the Social Services Committee came an equally withering and embarrassing report from the Audit Commission, which commented:
"It must be a matter for grave concern that although there are 37,000 fewer mentally ill and mentally handicapped patients today than there were 10 years ago, no-one knows what has happened to many of those who have been discharged. Some, of course, have died; others are likely to be in some form of residential care; the rest should be receiving support in the community.... If recent US experience is any guide, it is likely that a significant proportion of those discharged from NHS hospitals will have been before a court and will now be imprisoned; others will have become wanderers, left to their own devices with no support from communiti-based services."
Early in 1996 Stephen Dorrell said almost exactly the same thing. The Department of Health report The Spectrum of Care admitted that the closure of thousands of long-stay mental health beds had left thousands of chronic and severe sufferers without the care they needed.
Many of these chronic sufferers were inappropriately occupying beds in acute (short stay) units, where throughout the country bed occupancy figures have in many cases been pushed well above 100%.
The DoH report calculated that there was a need for around 5,000 extra places offering 24- hour nursing care for people with severe and enduring mental illness across the. country.
Each place would cost between £35,000 and €50,000 a year in revenue, while the capital cost of building the smaller-scale housing units would be up to £400 million. In London alone, where 60% of long-stay adult psychiatric beds have closed since 1990, the cost could be €70m in capital and E60m a year.
Without new money on this scale being pumped in to desperately underresourced mental health services, the - present shambolic, crisis-ridden arrangements were set to continue.
But of course Dorrell, like Dobson today, offered no extra cash to put things right.
A Daily Telegraph editorial, welcoming Dobson's apparent change of heart, bleated that - bad as services have become - "It would be unfair to pin all the blame on the Tories". While we can blame the Tories for reducing services to danger point over 18 years, we should begin now to blame Dobson and Labour if the only injection to mental health is another lungfull of ministerial hot air. • As we go to press yet another inquiry has been launched into yet another failure of mental health services, which led to yet another tragic murder - this time of a woman in south London. Acute psychiatric beds in Guy's Hospital were reported to have hit 230% last autumn, with staff at their wits end try. ing to contain and control seriously disturbed patients.
None of the lessons of previous such inquiries have been taken on board -because the system is fundamentally flawed, and the resources required are lacking.
The starting point of the inquiry should be how to attract sufficient cash, staff and resources to restore a viable service, and how to sweep away the chronic regime of buck-passing created by the Tory market system and community care reforms.
Socialist Outlook IOMB NEWS FEES
there are good reasons to doubt that anything will