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


Filed under Barbados, Health, Human Rights

12 responses to “The fallacy of “Community based care” for psychiatric patients

  1. weecooper

    Whilst I agree with the point that mental health care provision should not be budget driven, I am not sure how using such emotive language helps in any intelligent debate on this issue. “…don’t let their children play in front of the house……” – OH PLEASE!!! What sort of tabloid journalism is this!
    Mental health deals with an incredibly broad spectrum ranging from people who are able to live a completely normal life to those who, sadly, must be institutionalised – mostly for their own protection. Most mental ill health in Barbados goes completely undiagnosed. Mental health is not fixed and depends on lots of factors, many of which are modifiable.
    I believe in a community based approach but this needs more than words it requires a change in thinking and should NEVER compromise public safety.
    I believe this type of sensationalist article does nothing to help people understand issues of mental health and will make people less likely to come forward and seek help if they need it. There are ‘pressure cookers’ out there in our community just waiting to explode, lets take the pot of the stove rather than ignoring it!!!!

  2. Dis place want modernising seerious!

    I don’t think black Bajans (and this includes the black Bajan Government/s)
    have any idea what White Tourist Eyes see and think
    when they come upon all our disgusting, unsightly, unkempt PAROS, vagrants and Mad People we have in Bridgetown,
    sauntering around this city we hold up as a Tourism product.

    For decades now I have been saying that our vagrants should be rounded up, every single one of them, and housed, under guard -at either the Mental Hospital, or Dodds, or somewhere dedicated to their awful existence!

    We “don’t have the money for that?” –are you JOKING?
    We can afford to let them drag down the quality of our (fading!) Tourism product, instead?
    Which factor do you think will cost us more in the long run??

  3. Jocelyn Hunte

    Whilst not debating the pros and cons, I was very moved by the movie THE SOLOIST, the true story of a child prodigy, a former Juilliard student who was then homeless. Worth watching and seeing what a caring soul and music can achieve.

  4. Jocelyn Hunte

    Whilst not wanting to debate the pros and cons of the subject, I was very moved by the movie THE SOLOIST, the true story of a prodigy, a former Juilliard student who was found homeless, playing on the streets and what the treatment of a caring man and music, did for him.

  5. Seeker

    @ Dis place…

    Awful existence, eh?

    They’re human beings, just like you! Wonder what would’ve happened if YOU were in that position? Don’t paint all homeless with such a broad brush! Some of them WILL actually work, if given the chance!

    People becoming real cold nowadays…is a real shame…

  6. Sunshine Sunny Shine

    According to two news article reports, one in 2009, the other sometime this year, vagrants were responsible for the murders of two men. A few years before that I believe that either a police officer or some other innocent victim was killed by a vagrant in B’town. Then (speaking under correction again) a superintendent was involved in altercation with a vagrant which resulted in the officer having to wrestle the vagrant to the ground after he (the vagrant) struck the officer in the face.

    In the Oistins Baygarden which I visited a few years ago, there is vagrant who terrorizes patrons for food and is also known to walk with his manhood exposed at times. Now for a country that needs tourism it is my belief that they certainly do not need the vagrant situation to spiral out of control. But you know what it will. Barbados has a lot of troubled people who are facing immense pressures. It is unfortunate that the systems that cater to social development in Barbados need to do alot more surveillance and surveys to ascertain the mental health of its populace. I believe that our approach to this problem stems from how we priortirized things of importance. I can take this point a whole lot further but will contribute more at a later date. Gotta go now.

  7. Newbie

    I came across the dilapidated North Point Hotel totally by accident and thought what a waste. Here was a place that the Government could have taken over and used to house some of the homeless that sit or lie around in Bridgetown taking them way out of the city. It could also have provided a number of jobs for health care workers if remodeled as an institution. Yes everything cost money and needs brainstorming but Barbados is suppose to be full of big brains, I don’t think we have our priorities right, the welfare of people seems to come second to making money.

  8. Commander

    I have to agree with most of what the original poster wrote. the issue with community care as it is falsely called is that administrators and penny pinchers see it as a way to :

    1/ Save money.
    2/ Continue to ignore the problems that need fixing at the Psych hospital eg the significant numbers of wards that are often too dilapidated to be opened. (So do not be surprised when you see vagrants on the street …… there is no where for some of them in that institution.)

    Whereas the health care providers see it as a great way to focus their efforts on the more ill people rather than be a hotel for the indigent and mildly ill.

    Where the big problem comes is that proper community care really requires even more money than they are currently spending. That is partly why it failed in the UK. They want to put the patients out but are not willing to hire the staff to visit these people at the rate required rate or readmit the people why they have their inevitable breakdowns. they would have to keep almost the same numbers of rooms open and near the same staff numbers in the institution to handle relapses …………….. therefore a waste of money and risky patient care.

    I feel sorry for the polyclinic doctors who will be expected to pick up the slack and stop seeing their regular patients to accommodate this community care.

  9. Sunshine Sunny Shine

    The old North Point resort is under foreign ownership and according to reports steep in controversy. Government cannot touch it

  10. millertheanunnaki

    @ Sunshine Sunny Shine: November 13, 2011 at 3:21 pm
    “Now for a country that needs tourism it is my belief that they certainly do not need the vagrant situation to spiral out of control. But you know what it will. Barbados has a lot of troubled people who are facing immense pressures. ”

    Only recently, in August this year to be more precise I had a harrowing experience where one of these vagrants was harassing a couple visiting from the UK. I interceded to stop the obvious physical and verbal intimidation of the seemingly frightened visitors only to have my life threatened by this vagrant. As fate would have it, though, that person is no longer there forever to bother visitors to the Oistins Bay Gardens. Unless the nuisance posed by vagrants is brought under control the spillover negative effects to the tourism sector could cancel out any gains made by the wonderful publicity just received in the North American market.
    It’s amazing how Bajans can easily jump to labelling people who have resettled hereafter many years of living in the UK as “mad and weird” but can not look around them and observe the numerous street vagrants who are obviously suffering from mental illnesses and are unable to be accommodated at the obviously overpopulated psychiatric hospital!

  11. Barbados not serious about Product -only about advertising an image

    Get the vagrants, the paros, the homeless OFF OUR STREETS.
    They are a social eyesore, NOT befitting of a country that is alleged to be a developed country.

    We must live up to the advertising image we create.
    We are selling a Gold image.
    When tourists get here
    they don’t find gold.

    They find a Barbados littered with vagrants in Bridgetown and litter droppings everywhere else!

    In most ppl book that amounts to FALSE ADVERTISING!

  12. millertheanunnaki

    @ Barbados not serious about Product -only about advertising an image
    November 18, 2011 at 1:25 am

    This country prefers form over substance. It’s OK to spend big dollars getting “broke and nearly over the credit limit” Americans to come and enjoy what we have to offer; that all fine and wonderful!
    But what about the housekeeping and other hygiene factors necessary to keep the visitors impressed and to max out the credit cards!
    This vagrant problem with its attendant harassment and accosting –both verbal and physical- of visitors is something the authorities seem oblivious to. I suppose dealing with this problem will just as challenging as that of getting the NCC to remove immediately the debris and muck from the pavement after the drains have been “de-clogged”.