NHS cuts - mentally ill abandoned

As cuts to the National Health Service deepen, the mentally ill are being left to fend for themselves in what could be a crisis much worse than Margaret Thatcher's botched Care in the Community scheme*.

Reports are rampant that health authorities are making savage cuts to their psychiatric services, while a review of the NHS suggests that psychiatric care has never been more crucial to British society, especially to the over-65s.

The review, a collaboration between the Healthcare Commission, the Commission for Social Care Inspection and the Audit Commission, sought "to assess the progress of the NHS and local authorities in meeting the standards set out" in the National Service Framework for Older People.

It makes for grim reading. With one in six of Britain's population over 65, the proportion of mentally ill, believed to be one in five of the adult population, are facing a difficult future.

Living Well in Later Life, which was compiled with data from ten communities, reveals that those over 65 with mental health problems will not be living well. As Britain's population continues to age - by 2051 a quarter of the population will be over 65 - services for the mentally ill are diminishing.

In this environment, the three commissions fear for over-65s with mental illness. "There are poorer and less integrated services for older people with mental health needs compared to those people with mental health needs aged under 65," they state in the review.

"The out-of-hours services for psychiatric advice and crisis management for older people were much less developed, and older people who had made the transition between these services when they reached age 65 said there were noticeable differences such as poorer quality, fewer services and less support."

The commissions insist that "all aspects of mental health services for older people need to improve" and that "person-centred care" be available to everywhere, irrespective of their age. There has to be, the commissions state, a "a whole systems approach to the commissioning of integrated mental health services for older people".

But the NHS is in trouble, and these recommendations may well fall on deaf ears. Despite access to a budget of £92 billion, it has a deficit of £800m. Patricia Hewitt, Secretary of State for Health, insists the workers are to blame for rising costs. New pay deals for nurses, porters, care assistants, doctors and others are, she said, "costing rather more than anticipated".

"The fallout is hitting the mentally ill," said one carer. "They are being abandoned, it's as simple as that."

Philip, an Irishman who came to England several years ago because the psychiatric care is better than in his homeland, said: "It's not as good as it was."

By Robert Allen


*Care in the Community: In the mid 1980s the Thatcher government started a process known as Care in the Community. Her government were told by a report that people in the Victorian-style asylums were a disgrace to modern, civilised society and could be cared for in the community through various domiciliary supports.

The placing of hopelessly disturbed people in a society they could not cope with started in earnest. The safety net for these people was cut away. By the mid-1990s ex-psychiatric patients had swollen the homeless figures.

Suicides, and murder by disturbed, dangerous people started to appear on the inside pages of the national media.
When Jonathan Zito, a nice white middle class man, was killed by large black Christopher Clunis on the London Underground the scheme started to get a bad PR profile.

Care in the Community was shut down.