The latest report by the Inspector of Mental Health Services provides yet another disturbing insight into day-to-day life for many psychiatric patients. It records often appalling conditions in large institutions such as poor sanitary facilities, peeling paint and leaking ceilings in wards. Many of these wards had little or no therapeutic activity, multi-disciplinary input, regular physical or psychiatric assessments or care plans for patients. Some wards remained locked, despite the fact that only one or two in a ward required close observation.
While these details may be shocking, what is more alarming is the disclosure that patients are often not much better served in newer community services. Inspectors found that large community-based residences were more likely to resemble old institutions with little individual rehabilitation for patients and poor links with the local community.
These are damning findings. The transfer of patients from institutions to community-based services was supposed to provide an opportunity to modernise an antiquated service. It was meant to offer patients rehabilitation and a greater quality of life. Moreover, it was intended to lift the stigma that has surrounded mental health.
Instead, the move to community settings for many has been an exercise in relocation rather than rehabilitation. Patients in the vast majority of such settings have little input from multi-disciplinary teams. An opportunity to reduce the stigma and isolation that surrounds mental health has been lost in many cases.
An emphasis on care in the community, together with rehabilitation and support, is at the heart of the Government's 10-year plan published earlier this year to reform the mental health service. The report, A Vision for Change, sets out detailed plans for providing accessible, recovery-oriented, community-based services for people who experience severe mental health problems. If properly implemented, it has the potential to transform how people with mental health problems are treated.
It is unconscionable that after decades of neglect this blueprint should go the same way as Planning for the Future, a previous plan for change published in 1984. Significant parts of this policy document have not been implemented 20 years on. After decades of promises, health authorities are preparing to close down the last of the high-walled psychiatric institutions. Tearing down the walls of ignorance and indifference surrounding much of the approach to mental health, however, may take much longer.