Medium secure beds
Sir: I write with reference to your editorial of 30 September, 'Careless policy costs lives'.
There is no evidence that care in the community has led to an increase in the number of homicides committed by mental- ly ill people. Homicides by mentally ill peo- ple are rare but have always happened both in the community and in institutions. Severely mentally ill people are, as your editorial pointed out, far more likely to harm themselves than they are to harm other people.
The fact that these cases are rare does not make them any less tragic, and we are determined to further reduce this risk. We have introduced new measures to ensure closer and more effective supervision of severely mentally ill people in the commu- nity. Since last year, health authorities have been required to set up full independent inquiries into all homicides committed by patients of the specialist psychiatric ser- vices.
There is an international consensus that the community is the best place to provide care for the majority of mentally ill people. The term 'community care', however, can be misleading, as it encompasses a whole range of care options, including around 80,000 hospital and residential places.
Community care for mentally ill people is not, and never has been, an exercise in cost- cutting. NHS and local authority expendi- ture on mental health services continues to grow, and currently stands at around £2.5 billion a year. Firm instructions have been given to health authorities that savings from the closure of long-stay institutions must be re-invested in community provi- sion, and we have made it clear that clo- sures will not be approved until adequate community facilities are in place.
The problem of homelessness among mentally ill people is one I am particularly conscious of and we have already spent over £20 million in tackling homelessness among London's mentally ill.
In-patient beds and residential care for the most severely mentally ill people who cannot live safely in the community will always need to be provided. Suitable forms of 'asylum' for those who continue to need it is part and parcel of our community care policy. Such care is now usually provided in small local units rather than large, imper- sonal institutions.
The provision of medium secure beds is a different issue from that of long-term resi- dential care, and the editorial's comments on this subject were particularly misleading.
It has never been our policy to 'shut down' such beds. Indeed, prior to 1980, no purpose-built medium secure beds existed, despite the fact that the Glancy Committee recommended them in 1974. Since the first such beds opened in 1980, our central capi- tal programme to develop provision has created nearly 900 new places, and this will rise to 1,200 by the end of 1996.
Far from being complacent, this Govern- ment is fully aware of the continued effort which is required to ensure the successful implementation of comprehensive, commu- nity-focused care for mentally ill people, including asylum where necessary.
John Bowis
Department of Health, Richmond House, 79 Whitehall, London SW1
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