Pure Madness: How Fear Drives the Mental Health System

By Jeremy Laurance | Go to book overview

Chapter 7

Taking care to the home

Camden, north London, July 2001

Like many socially revolutionary ideas, this one was reputedly born at a Friday night party in Wisconsin, US, in the late 1960s. A group of psychiatrists were arguing over how to improve the mental health services. Someone suggested why not close the wards, send the patients home and send the staff after them? It would be better for the patients, who would be treated at home and better for the staff, who would be able to see what problems the patients faced - poor accommodation, perhaps, or difficult relationships - and offer appropriate support. And it would be cheaper.

Remarkably, the following Monday, in the cold light of day, the idea still didn't seem bad. So Professor Len Stein - known in some circles as the Nelson Mandela of mental health - and his colleagues set up a trial. Patients from three wards were randomly selected and placed in three groups . One group were sent home with support, one was left on the ward and one was sent to a ward with a special therapeutic programme. At the end of five months there was no difference in the condition of the three groups - so, the researchers concluded, there was no justification for keeping the patients in hospital.

Thus were community mental health teams (CMHTs) born - teams of staff providing treatment and support to mentally ill people living at home. The huge asylums for the long-term mentally ill were already opening their gates and decanting their residents into the community. Now the acute psychiatric wards were about to follow suit. From its beginnings in the US in the 1960s the idea spread to Australia in the 1970s but did not seriously catch on in the UK until the early 1990s.

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