LETTERS Stately care
Sir: Alasdair Palmer is almost entirely cor- rect in his denunciation of care in the com- munity ('Carnage in the community', 7 May), and Virginia Bottomley is almost entirely wrong in her support of it (Letters, 14 May).
It is, frankly, an insult to those of us who worked in the psychiatric sector in the 1960s and 1970s to have the Minister describe the genuine hospital care and good therapy provided in those days as 'Bedlam'. The Minister's view of the situa- tion appears to be based not upon the facts but upon the paranoid fantasies of R. D. Laing and the loony left hysteria of that dangerously distorting film One Flew Over the Cuckoo's Nest.
My first professional experience of psy- chiatric hospitals was in 1963, and by that time the leading hospitals had already unlocked their gates and unlocked their wards. By the time I became a member of the Health Advisory Service in the mid- 1970s even the most backward institutions — and it was our job to visit these — were also open and unlocked. How, then, can the Minister, presumably on the advice of her officials, accuse Alasdair Palmer of seeking to 'lock up those with problems . . . in cold remote institutions'? This is sheer emotive nonsense.
Many of those maligned institutions were, in fact, fine country houses set in their own grounds and staffed by caring professionals. (Unfortunately they also rep- resented valuable building sites and so have been sold off along with other items of the 'family silver'.) Patients often need refuge and security away from the strains of ordinary life; schizophrenics rarely thrive in the emotion- al atmosphere of their families. Many fear their own violence and are grateful to those who protect them from this.
What is so extraordinary is that the Gov- ernment does not seem to know or care how many murders are now committed by those who would have been hospitalised 20 Years ago; nor how many assaults, suicides, traffic accidents or sexual offences. Nor do they seem to know how many unfortunate schizophrenics sleep on the pavements, clog our casualty departments, take up the time of the police and the courts and occu- py our prisons. Patients and their relatives are often made miserable by the present situation.
It is surely true that proper care in the community would be vastly costly. But I am also convinced that even our current heart- less travesty of community care would be revealed as far more expensive than hospital care if only the Government accounted for it across all the services which are now involved, for example, police, courts, GP, paramedical, probation and prison services.
Why does the Government not do this?
Dr Richard D. Ryder
Hay House, Haytor, Devon
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