Pure Madness: How Fear Drives the Mental Health System

By Jeremy Laurance | Go to book overview

Introduction

The knife came from behind, in a wide arc around the shoulder, swung with great force so it penetrated the orbit of the right eye and entered the brain. The victim had no time to react or to defend himself. He was caught by surprise, unaware of the presence of his assailant, a complete stranger, behind him. He had been picked, apparently at random, from among the crowd of people standing on the station platform waiting for a train. His assailant turned out to be a mental patient who had been shunted back and forth in the mental health system and had seen more than 43 psychiatrists in five years.

The killing of Jonathan Zito by Christopher Clunis, a man diagnosed with paranoid schizophrenia, on 2 December 1992 marked a watershed in the history of mental health care in Britain. Up to that point the focus of concern had been on the welfare of patients discharged into the community as the huge Victorian mental asylums closed. Many were living impoverished lives in dingy bedsits and seaside boarding houses, forgotten and ignored. Stories exposing their plight had shamed politicians and the public and fuelled doubts about the hospital closure programme.

After the Zito killing, the nature of the debate about mental illness changed. The focus shifted from the care of the patients to the protection of the public. The psychopathic murderer - the mad axeman of popular myth - became the new monster in our midst. Risk avoidance and public safety became the new watchwords.

The switch of emphasis had an enormous impact on the care of people with mental health problems. Concern about the welfare of the many was replaced by fear of the risk posed by the few. There are an estimated 600,000 people in England with severe enduring mental illness, most of whom have a diagnosis of schizophrenia or manic depression, but less than 1 per cent of them (4,000 people in England) are judged to need intensive care because they pose a risk to

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