Failure in community care: psychiatry's dilemma

Health care professionals will be more accountable for failures in the future

After decades of scandals associated with substandard care in institutions1 come scandals in the community. Concern has mounted as fears for the plight of abandoned mentally ill people on the streets2 and in remand prisons3 have been overshadowed by a series of incidents in which discharged patients have harmed themselves or others.4 5 The media have seen through political policy and professional dogma that state that the mental hospitals can close and seriously mentally ill people can be conveniently and easily managed in the community. Some health care professionals have argued that more resources are the answer. But others privately doubt the suitability of community care for a substantial minority of patients and suspect that unquestioning enthusiasm for its implementation has contributed to the current problem.

The response of the secretary of state for health has been to make professionals more accountable for these failures in the future. Detained patients will be subject to supervised discharge, whereby a named professional is directly responsible for their care.6 A treatment and follow up plan must precede discharge, and subsequent failure to comply with conditions will result in a review of the case and a multidisciplinary meeting to decide whether the patient should be recalled to hospital under the powers of the Mental Health Act 1983. No new resources are being provided to set up supervision registers or to meet the inevitable increase in sessional commitment from health and social services professionals. There are no guidelines on what …