The Asylum vs. Care in the Community.

When I was growing up in Stoke, the reputation of our local psychiatric hospital took on almost mythic qualities. Based in Cheddleton, the St.Edward's hospital was the subject of many, possibly apocryphal, stories, and whenever anyone would act a little "crazy", people would always say "be careful, you'll end up at Cheddleton". The remark was usually delivered in a derisory or humorous fashion, and what it made clear was that those who actually did find themselves "at Cheddleton" were separate from the rest of us. "They" were the insane, while we were, to quote Foucault, shining examples of "a reason sure of itself". So, the element of stigma was clear. The inmates of St.Edward's weren't like us. They were almost a different species, the insane, and I remember thinking very clearly that I would never end up in such a place. Little did I know.

St.Edward's Psychiatric Hospital, Cheddleton.

But what this got me thinking about was the eventual closure of St.Edward's and other places like it, with them eventually being replaced by so-called "care in the community".
The drive for this change began in the '50s and '60s, when there was a rise in patients' rights movements, in turn tied to civil rights campaigns. The stories of many languishing in the long-stay asylums aroused such campaigns, the object of which was to end the isolation of the mentally ill and integrate them back into the community, thereby reducing the stigma attached to such conditions. The 1959 Mental Health Act abolished the distinction between psychiatric and other hospitals and encouraged the development of community care. During the '70s, large-scale psychiatric hospitals were steadily discredited and the setting up of new district general hospitals resulted in a reduction of beds from 150,000 to 80,000 by 1975. The 1983 Mental Health Act set out the rights of those admitted to psychiatric hospitals and allowed them to appeal against committal.
So, so far, so good, one would think. Indeed, attitudes had changed as well. No longer was homosexuality viewed as a matter of mental ill health, and no longer would single women who had fallen pregnant be detained in the old-style Victorian asylums.
However, throughout the '80s and '90s there were a number of high profile cases which led many to question the efficacy of "care in the community". In 1984, social worker Isabel Schwarz was murdered by a former client, which led to a government inquiry into community care. The resulting report, "Community Care: Agenda for Action" was a forerunner to the Community Care Act of 1990, and after a number of similar cases in the '90s, most notably that of Christopher Clunis, who killed Jonathan Zito on the platform of Finsbury Park tube station in 1992, the debate over whether community care was a good idea raged once again. "Forget the patient's rights", the right-wing press seemed to declare, "what about the public's right not to be attacked and killed?" Such was the frenzy of accusation, that the then government proposed controversial changes to mental health law concerning those with severe personality disorder, which would make treatment for them compulsory. Many argued that such changes would infringe patients' civil rights and turn doctors into jailers, and what appeared to have been forgotten was that such cases were really a rarity. The vast majority of murders are committed by "sane" people, but no one ever seems to speak of this violent epidemic spreading amongst the sane.
So, perhaps the question to be asked is did "care in the community" really achieve its aims? Sure, patients' rights have been significantly advanced, but has it had the desired effect of also reducing stigma? Indeed, has it really improved the care of those with experience of mental ill health?
All I can say is that many mental health staff and indeed, also service users, refer to the old long-stay institutions with a certain fondness. St.Edward's itself was set amidst beautiful grounds, and it seemed to be a time when the word "asylum", with its true meaning of sanctuary and protection, was entirely apposite. For many with mental ill health, some time away from everyday life and its problems can be invaluable in their recovery, and I remember one service user stating to me that, contrastingly, "care in the community" really meant "no care in the community".
Speaking for myself, though, I have to say that I wouldn't welcome a return to the old long-stay institutions. The set-backs are simply too many. And if I were around in the '50s, before the impetus for community care came about, who is to say that I wouldn't, with my diagnosis of schizophrenia, be languishing on some grey ward. The problem of stigma, I also have to say, seems to be improving.
In the place of St.Edward's then, we now have the relatively new "Harplands" hospital. But, having made the previous positive comments, I would say that its reputation amongst service users is not that great. One lady, who had experience of depression, even remarked when speaking on our local BBC radio station, that she would rather have committed suicide than go on an acute ward at the Harplands. So it seems that any psychiatric institution will always be feared, and maybe, the old Stoke saying of "be careful, you'll end up at Cheddleton" has merely been replaced by something to the effect of, "be careful, you'll end up at the Harplands".