There has been a move away from hospitalisation and towards caring for, and treating patients with schiz in the community. The number of hospital beds for the mentally ill has been reduced bya round 2/3. There are a number of reasons for this decline:
- The antipsychiatry movement in the '70s and '60s led to a rejection of medical concepts of mental illness and a preference for support in the community. Research was also emerging that institutional psychiatric hospitals could be detrimental to the outcomes of people with schiz, as such places were dehumanising and increased negative symptoms (Wing and Brown, 1970).
- The discovery or neuroleptic drugs allowed psychiatrists to expand outpatient day care for schizophrenia.
- The current approach to community care emphasises interventions between psychotic episodes to maintain the benefits of treatment and prevent relapse. Case management is considered to be an essential part of community care models. This way of tailoring help to each individual's needs by placing the responsibilty for assessment and service co-ordination with one individual worker or team (Onyett, 1992). A client will be allocated to a named key worker, usually a psychriatric nurse, who has to assess and coordinate appropriate care. This requires input from a variety of other organisations, such as occupational therapists.
Stein and Test (1980)
AIM: to investigate the efficacy of community care over inpatient care, followed by aftercare
METH: a comparison was made of 2 group of 65 individuals, one group was recieving inpatient care plus aftercare (control group), the other was recieving training in community living, which included developing social support networks, reducing dependency on family/institutions etc.
RESULT:during the first 12 months, 58 of the control group were readmitted to hospital whilst only 12 of the community living group were readmitted. However, when the programme ended, the gains were gradually lost.
CONC: The patients in the community programme were not cured, but were able to survive in the community, owing to the avalibility of supporters and carers during the programme
EVAL: this study made it clear that a considerable financial and personnel investment is required for community care to be effective long term. This is a political issue that needs to be adressed nationally.
Eval of community care
- Those who favour community care argue that the quality of life can be improved at no extra cost
- Hospitals are seen as places that increase some of the symptoms of schiz, such as apathy and withdrawal, and stigmatise those with a mental illness
- Critics of community care arue that services are often patchy, and the burden on families increases.
- Failings in community care have been highlighted in media reports of tragic cases, such as the murder of jonathon zito on an underground station in London