Does the community care?

Lets not argue about the fact that if, as the Telegraph has it, a climate of : kicking, shoving and dragging, belittling, goading and mocking … withholding food, giving cold showers, overzealous or premature use of restraint, poor attitude towards people who used services, poor atmosphere, roughness, care not provided, lack of dignity and respect and no privacy was found to be systematic in British prisons or at say, Guantanamo bay, then the comments boxes at Harry’s Place would be buzzing and the wider media would have entered a feeding frenzy.

Yet as the Police yesterday started a criminal investigation what is said to be the “worst case of widespread abuse” ever seen in Britain, informed comment on an issue which you would need a busload of faith to believe is confined to Cornwall amounted to a trickle. The gentle quill-hands of the press were forced to confront the fact that they have not the slightest idea of what actually goes on inside the small “community care” units where well over a million people now live and in which 5% of the UK workforce are employed.

The original aim of “care in the community” was to “normalise” care and thus remove the stigma from people suffering from mental illness and those who were born with learning difficulties. The 1959 Mental Health Act abolished the distinction between psychiatric and other hospitals and encouraged the development of smaller units. In the spirit of civil libertarianism people such as former health minister Enoch Powell, (to some the Father of Community Care), argued that mental hospitals were effectively prisons where institutionalization prevented any return to normal life for their inmates.

During the 1980s many large psychiatric and mental handicap hospitals were closed and demolished (and most of the sites were then covered with commuter housing faster than you could say “Michael Heseltine.”) These vast 19th and early 20th century institutions will not be missed. The often gothic and always sinister buildings were usually hidden in rural areas and concealed a harsh regime where less able patients were wheeled into a room in the morning and left sitting in a circle awaiting mealtimes. If they were very lucky staff might notice that they had soiled themselves, on a good day something might even be done about it. Meanwhile outside in the vast grounds a Hobbsean hierarchy of violence held sway – with the more able forming gangs to rob and rape the weaker. In such “hospitals” the staff were almost as institutionalized as the patients.

The two hospitals which I visited before their closure -Darenth Park and Bexley hospitals in Kent- really were the closest thing to hell on earth that I ever want to experience.

During demolition, patients (now re-branded as “clients”) were moved into ordinary houses which they shared with (usually three or four, but sometimes up to 12) other ex long-stay hospital patients.

The belief was that community care would be cheaper than hospital care. I’d also suggest that some government whiz-kid thought that the old institutionalized staff of the big mental hospitals could be dispensed with quietly and replaced with an army of rather “right-on” artistic types from the dole queues.

There are all sorts of people running community care homes: from the whackily “alternative” to the frighteningly suburban. But there is always a situation where a small group of staff have a frightening amount of power over physically weak or confused residents who are often on drugs and sometimes violent (one study suggests that 58% of staff have been exposed to violence or threats of violence.)

In such a situtaion it is very easy for a culture which overlooks abuse to be formed. Stories such as the Independents of staff removing all taps because of misbehaviour by a resident are common. It really is a strange sort of “normalization” when you are forced to remove twelve people’s rights to wash their hands…

Many staff feel that the public image of their work is very poor and that the general public has no real understanding of what they do or what goes on in a community care home. With shifts lasting up to 24 hours (one place I worked had three staff to cover the care of one resident for 24 hours a day, 365 days a year) staff can feel isolated and there is a situation where “going native” is far from uncommon. If you want to know where a 21st century Mr Kurtz may be found then I suggest you look no further than a house in your own street.

Lets be straight, “Community care” is an improvement on the old hospitals, but that should not blind us to the dangers. As managers in NFPO’s have become responsible for their own budgets and workers who took the jobs for altruistic reasons have become disillusioned and moved on, standards are slipping and it is a possibility that many NFPO’s could eventually become indistinct from private care homes or even the hospitals built by Victorians who convinced themselves that they were doing the mentally ill a favour by removing them from public view.

As a student I worked in such a private mental-health “facility” for about a year. This place (described as a “hell-hole” by a friend who attended a job interview) was home to 12 people, for whom the social services paid around £300 a week each. Despite the “clients” adding up to 80% of their personal benefits the weekly shopping bill amounted to about £80. Council inspectors tut-tutted, made asides about meanness and passed the establishment as “fit for purpose.” Staff came and left weekly and were often hired without any basic criminal checks, Patients recounted tales of abuse and showed bruises to unsympathetic staff – nobody listened. One “client was taking a large dose of prozac prescribed to him by his own GP and at the same time visiting Harley street to get supplies of other drugs privately.

David Congdon of Mencap says that there are some simple lessons to be learnt from the Cornwall case.

“If you have an institution that is very inward-looking then things can go unnoticed. It’s much better if there is an open climate, with lots of visitors.”

The community care homes which I worked in were lucky to see one outside visitor a month. Usually the same relative who had been effectively “co-opted” into the prevailing values of the staff group.

If you really wish to make the world a better place then instead of picking up one of those ready-made SWP placards on the latest trendy cause or picketing “Islam expo” why not just become a regular visitor to your local community care home?