Care in the Community

Over seven years ago I began a series of drawings to warn the other patients, and staff, at the day centre, of the problems caused when the drug users and street drinkers befriend the care in the community  patients. The drug users and street drinkers are after the patients higher rate benefit and will steal borrow  sell the patient drugs or encourage them to drink alcohol to get it. Recently the police have acknowledged this problem, and have given it a name, ’Mate- Crime’. I believe that this problem which has increased since the introduction of the care in the community initiative is partly responsible for the increase in violence by psychiatric patients and in turn responsible for the continuing stigma that patients have to endure. 
Patients, especially schizophrenics, according to one theory, suffer from a chemical imbalance. The process responsible for dreams overspills into daily life. When the patient is so affected that he cannot distinguished reality from fantasy he or she is said to be psychotic. I t when this occurs that the patient is likely to become distressed and bewildered and in some cases violent. In the hospitals this condition would be recognised and treated, the patient sedated or if need be put into isolation. In the community the condition is left unchecked, fearing sedation and isolation the patient may not contact community nurses social services or carers. 
Though this condition may be precipitated by the patient neglecting to take medication, as is popularly believed, patients are disinclined to remain medication compliant in the community for a very good reason. The drugs that are prescribed to block the unwanted messages from the brain that cause confusion during waking hours also block some of useful messages causing unpleasant side effects such as parkinsonism, (the shakes), and dyskenesia an unpleasant muscle condition. These side effects and associated ill health mark the patient out in the community as a target for bullies.
The situation is made worse when patients are sectioned and forced to take medication, or coerced into becoming medication compliant. Often medication is unnecessary and it is only prescribed for want of nursing or occupational therapy. This causes resentment anxiety and frightens the patient, causing distress, sometimes provoking anger. But this anger is almost always seen as a symptom of the original psychiatric illness, and usually results in the psychiatrist increasing the medication and so the situation snowballs, as in the case of Rose Murphy, which I describe in my book, The Road to the Asylum’. Sometimes this situation results in homicide or suicide. These fatalities are put down to neglect or non-compliance when in fact the misuse and over prescription of medication, widespread throughout the mental health service, may be the cause.  
The N.I.C.E. guidelines recognise that long term use of these drugs may result in serious long term health problems. such as heart disease, diabetes and cancer. The N.i.C.E. guidelines also recognise that alternative therapies among them art therapy that can have a calming effect on the patient, and cognitive behavioural therapy and counselling where patients can learn non chemical coping skills. Alfred Wallis the painter was tormented by voices. He believed they resided in this chimney. He would get a friend to clear his chimney of voices with a bit of string and some wire and be free of the voices for a couple of months when the friend would be called again to clear the chimney of voices. Of course the voices did not really reside in the chimney but the fact that the voices stopped after he procedure indicates that the voices were in part at least psychosomatic.

 Whether the patient is maintaining daily life with or with medication, whether symptoms are controlled by medication or coping by some other means, the balance of their mind will very likely be disturbed if the resort to using street drugs or alcohol. Again if the patient becomes psychotic there is an increased risk of violence or self ham. Either way the community is at risk from this problem. But as I hope I have shown  the problem is not just with the patients but often lies in the fact that the patient is vulnerable to elements of society that are keen to exploit them for their money and often to use their premises for illegal purposes.
The small time drug users and pushers with addiction problems  feel that they are treated badly by a society that in effect outlaws their addiction. These drug users feel compelled to commit crimes to to pay for the drugs they need to prevent withdrawal symptoms..
Patients, staff and the public alike seem remarkably unaware of this situation so I started the series of drawings to raise awareness as no-one seemed to want to listen. 
I also made a series of drawings to show a modern day version of the Rake’s Progress, set in the 1970’s based on events I had witnessed at that time.

Recommendations;
 
The government has to admit that the care in the community programme has been a mistake. Psychiatric patients need more long stay and secure unit beds.
Patients isolated in the community need day centres and day hospital facilities restored along with occupational therapy units not subsidised day and evening classes or referrals to the internet. Perhaps when society is more aware of the situation then this might be more realistic. I know that some patients that are non aggressive and stable can attend classes but many, probably most cannot.
There will always be those who complain about the cost usually these types would have to have paid many times the actual tax that they contribute if they had made any significant contribution to every public funded expenditure that they did not approve of. I do not believe that the cost of the old wards was any more than that of care in the community and that in any case the cost in human misery  caused by the hospital closures is incalculable. The public need to be informed of the situation to dispel the prejudice patients endure on a daily basis and need to adopt a more aware attitude towards the problem of drug abuse among the mentally ill, naming and shaming those who exploit the mentally ill if not increasing penalties for selling drugs to the mentally ill. Those that sell drugs to the mentally ill should be regarded with the same contempt as those who sell drugs to children. However it is also true that those who are addicted to drugs are unnecessarily outlawed and this may contribute to the problem. If addicts were allowed to obtain their drugs legally and the object of treatment was to enable the addict to start or return to work, then they would not have to deal with their present criminal status or have to buy from the black market. They would have more time to treat their illness and would be less likely to commit crime. 
The government needs to recognise the problems associated with the over prescription, inappropriate use, and long term use of anti psychotic drugs. The government should look into the alternative ways of coping with psychiatric symptoms so that psychiatric patients in the community might remain able bodied for longer and so be able to lead more rewarding lives.

                                                                                                   David Beales