Out of the Asylum Era

The charity Turning Point turns 40 this year. Known for its work
with people with learning difficulties, mental health problems and
substance misuse problems, it has commemorated its anniversary with
a report looking back on developments in social care.(1)

Since the first Turning Point project was opened in 1964 for street
drinkers in Camberwell, south London, the social care landscape has
been transformed out of all recognition. Arguably, the biggest
change has been the closure of almost all the old Victorian
hospitals for people with mental health problems or learning
difficulties, and the transfer of in-patients out into the
community.

Mental health

The old Victorian mental institutions were associated with
violence, forced and often primitive “treatments” and a lack of
dignity and independence, and you would be pushed to find anyone
who regrets their closure. However, for many former in-patients the
change was just from a large institution to a smaller one.

Gil Hitchon, chief executive of the mental health charity Maca,
says: “The view was that small is beautiful. Care in the community
was generally positive for people who’d lived continuously in
hospital for 20 or 30 years. But there wasn’t enough support to
help them integrate in what was often an alien environment. A large
number of small homes were set up without proper assessment.”

Hitchon also believes a lot of people were moved into small
community homes with no adequate assessment of their needs. “Not
all of the people living there need 24-hour care,” he says.

He sees the Registered Homes Act 1984 as pivotal in improving
standards in community homes. “It created a framework for really
significant inspection and improving standards.”

Another important development has been the greater recognition of
individuals’ rights. “Over the past 10 or 15 years the voice of the
user has become infinitely stronger, but there’s still a long way
to go,” Hitchon says.

But he believes that although psychosurgery has been confined to
history, the medical model is still dominant. “A lot of people just
get drug treatment and don’t get any therapy. There has been
progress in focusing on people’s social needs, but we still work in
a context that focuses on deficits rather than people’s
strengths.”

Learning difficulties

Forty years ago most people with learning difficulties lived either
with their parents or in a large, long-stay institution. Today they
live in a wider range of settings, including their own
tenancies.

Brian McGinnis is chair of L’Arche UK which provides community
houses for people with learning difficulties. He believes that
direct payments, introduced in 1996, could give people a much
greater say in their lives. “If what you want is to go and play
football rather than whatever the local day care service happens to
provide, there’s the potential for you to do that.”

But this potential is not being exploited, he says. “At the moment
direct payments are largely irrelevant because there’s no support
for people to use them and no market to buy into.”

Mark Brookes, a project worker at campaigning organisation Values
into Action who has learning difficulties himself, believes the
rise of the self-advocacy movement over the past decade has had a
major impact on services. “The message is going out that people
with learning difficulties can run an annual meeting or a
conference.”

But funding can be a problem. He says: “Councils are starting to
listen, but they don’t always have the money to do what people
want.”

Drug misuse

Drug treatment services have mushroomed over the past 25 years as
the number of problem drug users has risen. In 1979 provision for
this group was confined to GPs prescribing pharmaceutical heroin to
registered addicts, and a handful of treatment clinics.

Today, we have near-national coverage by a host of services, from
substitution therapy and needle exchanges to detox and rehab.

Jane Christian, service manager for Druglink in Staffordshire, has
worked in the field since 1979. She feels the seamless matching-up
of different services is still lacking. “There are attempts to join
things up around mental health and drugs, and I do see progress
with support for training and employment,” she says. “But the
biggest gap is housing. If someone is treated for their drug
problems but are homeless, they are more likely to start using
again. We still aren’t good at supporting people with multiple
needs.” CC

(1) Turning Point, Turning 40: Four Decades of Turning Lives Around
and a Vision for the Future of Social Care, Turning Point, 2004,
www.turning-point.co.uk

Learning Difficulties: Key Developments

• 1969: There are 58,850 people with learning difficulties in NHS
  hospitals.
• 1971: The Education Act recognises that people with learning
  difficulties have a right to education.
• 1995: The Disability Discrimination Act strengthens civil
  rights for people with physical and learning difficulties.
• 2001: The Valuing People white paper is published, setting out
  policies to boost choice, independence and inclusion.
• 2003: There were still 750 people with learning difficulties in
  long-stay hospitals.

Drugs: Key Developments

• 1971: The Misuse of Drugs Act classifies drugs into classes A,
  B and C.  
• 1989: Prime minister Margaret Thatcher steps up the war on
  drugs with the “Just say no” campaign.  
• 1995: The Conservative government launches a national drugs
  strategy.   
• 1998: Drug treatment and testing orders are introduced as a new
  community sentence under the Crime and Disorder Act.  
• 2001: The National Treatment Agency is set up. A year later the
  drugs strategy is updated.  
• 2004: There are estimated to be about 250,000 problem drug
  users in the UK, plus about two million people with alcohol
  dependency.

Mental Health:  Key Developments   

• 1966: There are 107 hospitals for mentally ill people, each
  with at least 200 in-patients.  
• 1981: The Care in the Community green paper recommends closure
  of long-stay hospitals.  
• 1983: The Mental Health Act provides safeguards for people in
  hospital.  
• 1991: The Care Programme Approach is introduced to support
  people with mental health problems.  
• 1999: The National Framework for Mental Health is published,
  setting out national standards for services.   

‘I have Thatcher to thank’

Andrew, a paranoid schizophrenic, lived in asylums in East
Sussex between 1974 and 1990. He is sure the closure of the big
hospitals has been a step forward.  He says: “It was the revolving
door syndrome – you were admitted, injected with drugs once a
fortnight, sent to the industrial therapy unit and kicked out again
after a few months, and expected to do a job and pay all your
bills. The pressures of poverty and living in a place with no
heating were pretty intense, and sometimes I’d ask to be
readmitted. I didn’t even have a social worker.  “Since 1991 I’ve
been supported in the community [living in Maca accommodation]. Now
I have a social worker and the support of a day centre. It’s a lot
more dignified and there are more choices. They’ve encouraged me to
complete my studies – an honours degree and masters in social
policy. My life is much better but I don’t think my condition has
suddenly changed.  “I’ve got Margaret Thatcher to thank for closing
the asylums. She’s not someone you necessarily associate with
social improvement, but it was her who did me that favour.”