Daily Archives: November 12, 2011

The fallacy of “Community based care” for psychiatric patients

“This is all budget driven and it will turn out very badly”

by One Who Knows

There are two stories in Barbados Today that should be required reading for every business person, landlord, tourism worker, shop clerk or shopper who has ever had trouble from the mentally ill vagrants who prowl the city looking for their next victim. The stories should be required reading anytime you smell urine in the air while walking past the War Memorial or find human waste on the beach.

The Psychiatric Hospital announced they are cutting 230 beds over the next ten years and they intend to do this by implementing the same Community based care model that has proven to be a disaster throughout major cities in the UK and America.

People who used to be looked after and did moderately well with daily care at hospital residences now populate the ranks of the “homeless” throughout the UK and the USA.

These poor souls used to have health care, hygiene facilities, nutritional standards and behaviour monitoring with professionals ready to intervene. Now they sleep under bridges and in parks: malnourished, without medication, filthy, lonely and socially outcast. Their mental health always slides on the outside. Always.

That is the outcome for the vast majority of “former” psychiatric patients tossed out on the street due to budget cuts. That is the history of “community based” mental health care.

Community Care does not exist except on paper during budget proposals

The fallacy is that you can cut the budget for looking after psychiatric wrecks by shoving them into the community and providing them with “community support”.

This word “support” is never defined by minimum standards of care, budget or monitoring to ensure patient and community safety. This “community support” is a vapourish term that means anything people want it to mean at any time.

“Community Support” always ends up meaning that people who need serious attention now live next door to you and your children. It means that patients who can barely make it through the day in a professionally staffed hospital residence are now on their own.

Model patients in hospital residences can become dangerous when the system tosses them onto the street. Read the big city papers anywhere in the USA or the UK and you’ll see the same story over and over again: After an incident where the patient or an innocent victim is hurt, authorities talk about how well the patient was doing and how this incident is an anomaly in an otherwise effective programme of Community-based care etc etc etc.

Health Minister Donville Inniss and the other proponents of Community based care for psychiatric patients never talk about increased costs that happens in other areas when the health system unloads its burdens upon the community. They never talk about the increased costs for policing and ambulance services. They never talk about increased crime and violence in the community. They never talk about the deterioration in the quality of life for ordinary people and about mothers who don’t let their children play in front of the house anymore unless someone is right there all the time.

Community based care proponents never talk about what happens when two or three borderline patients move into a neighbourhood and disrupt the lives of hundreds of people every day.

Read the two Barbados Today stories and know that this is all budget driven by the government: not driven by the health care professionals who are trying to cope with the budget reductions and know how this will turn out.

Reduction in accommodation Psychiatric Hospital’s goal

Helping the homeless

Remember my words: Community based care for mental patients is a fallacy that always turns out badly. Always.

Submitted by One who knows

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