Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 89workhouse in South London) were considered mentally ill in the early 1970s. 29 Atthis time, too, concern developed over the increasing numbers of mentally illcriminal offenders who were incarcerated in prison or borstal, though theproportion of prison inmates suffering from schizophrenia was lower in Britainthan in the US. 30The Social Services Act of 1970 transferred the responsibility for many aspectsof community care for the mentally ill away from local health authorities andplaced it in the social services departments. Many professionals feel this was not asuccessful move. In 1976 only 43 per cent of the recommended minimumnumber of places in hostels and group homes had been established and dayfacilities were equally scarce. Some local authorities had provided none at all. 31 Asurvey of the social situation of 190 people with schizo-phrenia living in thecommunity in Salford in the late 1970s revealed 30 per cent accommodated inslum housing, 16 per cent with inadequate nutrition and 34 per cent who spentall or most of their time doing absolutely nothing. Among more than 100patients, most suffering from psychosis, in the psychiatric wards and day hospital ofthe London Borough of Camden on a single day in 1976, one-half were knownto have been living alone before admission, nearly a third in transitoryaccommodation (such as abandoned homes, doss houses and reception centers) orsleeping on the streets; two-thirds were totally unemployed, most of them formore than a year; and more than a third of the inpatients received no visitors.Many of these patients, clearly, had no worthwhile community links, but despitetheir obvious social deprivation only six per cent of Camden’s inpatients weresubsequently discharged to any kind of supportive setting, such as a hostel orgroup home. 32 Such “rehabilitation” was not what the innovative Britishcommunity psychiatrists of the 1950s had in mind. Hospital conditions alsodeteriorated in some parts of Britain in the 1970s. Government reports, coveringthe period from 1976 to 1982, record the widespread existence of overcrowding,understaffing and custodial attitudes to patients throughout mental hospitals inmany counties. Instances of cruelty and neglect were documented. 33AND NOWRecent developments in British mental health services still leave room forconcern. Only 14 of the 130 hospitals operational in 1975 remain open in 2002. 34Critics of British community care draw attention to patient neglect andhomelessness and point to inadequate funding and poor management. Newspaperreports focus on vagrancy, suicide and the plight of mental patients isolated inbed-sitters, and suggest that community care has turned into communityabandonment. 35 The number of homeless people in Britain doubled during thedecade leading up to 1992, and the proportion of mentally ill among the swellinghomeless population remained constant. Half of the residents of a hostel forhomeless women in London in 1991 were found to be suffering from severemental illness, many exhibiting high levels of active psychotic symptoms. 36 Of the