On the whole, care in the community seems to have had huge benefits
for large numbers of people over the past 20 years. There are
thousands who would have been living in massive institutions,
dependent on their custodians who, with the best of intentions,
decided how they should live, what they should eat and where they
could go, irrespective of their charges’ ability to make decisions
for themselves. Institutionalised and in effect powerless, most
people with disabilities were prisoners of the welfare state.
Whatever the current problems of care in the community, there are
more opportunities for most of us to determine our own lives. But
one of the major failings of the reforms of the past two decades
has been in the care of some people with mental illnesses and
This is not a criticism of the professionals who work in mental
health: far from it. In my opinion, they have been working with one
hand tied behind their backs for a long time. The problem lies with
the system itself, and lack of political courage to address
commonly held attitudes. Dangerous, disruptive and violent
behaviour used to lead to admission to an asylum. Now, a large
proportion of the prison population is there due to mental illness.
The problem with this situation is twofold. Some people with mental
illness are being held accountable for their behaviour when they
have had little or no control over what they have done. They are
being punished for behaviour for which they should not be held
Under punitive conditions, illnesses go at best untreated and at
worst aggravated by the circumstances, with no effective
preparation for the prisoner’s return to open society.
It seems to me that the proposals in the Mental Health Bill run the
strong risk of making the situation worse for those who are being
treated and live in the community, reinforcing society’s
stereotypes of mad equals dangerous, of those with little control
over their own behaviour culpable, making their homes into prisons
and their carers into jailers.