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The Lost Concept of Asylum Delroy, 37, worked as a housing officer before he was admitted to the psychiatric unit of a Bristol hospital for six weeks at the beginning of 2000. He found the experience as an in-patient extremely distressing. "The ward was dreadful, offering no therapy only chemical treatment " he said. "And I was accused of 'misusing my mobile phone' by nurses when I rang friends to complain about the conditions." (Name of caller has been changed) In the last twenty years, 50,000 psychiatric beds have been lost. Acute in-patient wards in every big city are grossly overcrowded, with occupancy rates running consistently between 110% and 120%, against a recommended rate of 87%. The number of patients who have to be compulsorily detained in hospital has trebled since 1980, and in some places only patients referred from the courts or under a section of the Mental Health Act secure a bed. Conditions on some wards are so bad that patients have to be detained compulsorily because they do not want to stay voluntarily in appalling conditions. In the last ten years there has been a nine-fold increase in private psychiatric care, often requiring patients to be treated far away from home. For families and carers, premature discharge from hospital because of pressure on beds, or inability to obtain a bed, mean unsupported home care. For professionals, there is the constant dilemma of whether to discharge someone who is still acutely disturbed or turn away another patient who may be just as much at risk. With the loss of beds through closure of the old psychiatric hospitals, and the failure to replace them with sufficient nursed beds and supported housing, we lost the backstop of a place to go when a person is no longer able to cope on their own or living with their family. We have also lost the concept of asylum; a place of refuge that recognises that people at some points in their lives and in their illness may need time and space away from the multiple stresses they feel. Prevention of suicide A survey of 10,359 people who contacted SANELINE between January 1996 and June 1998 reporting a history of mental illness and suicidal intentions showed that half of the callers had attempted suicide in the past, and that almost one-fifth were planning it at the time of the call. The survey showed that more than three-quarters of the suicidal callers had been in contact with a health professional in the month preceding the call. Rachel, 58, called SANELINE regarding her son, Darren, aged 33. Darren was diagnosed 17 years ago with schizophrenia and during that time, Rachel has been fighting for the correct level of care for him. Darren is often unwell and neglects himself. Was in hospital voluntarily and recently discharged himself. Rachel wasn't informed about this for days. He is now back in his "filthy" flat and not taking care of himself and has had no follow-up visits. Rachel has made formal complaints but received only had platitudes from the hospital. "We live in fear of a knock on the door saying that Darren has killed himself," Rachel said. (Names of caller and her son have been changed.) SANE has also carried out a pilot study of 21 cases of suicide based on information provided by bereaved carers. This showed that one in three of those who had previously attempted suicide had received little or no follow-up care after contact with services. In March 2001, the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness published a report on 5,582 suicides and 186 homicides by psychiatric patients, of which 1,280 were judged to have been preventable. Of the vast majority of patients who committed suicide outside hospital, 40% did so before the first follow-up appointment. In the light of these findings, SANE has called for an initiative to give more intensive support to people who are on leave from or have been just discharged from hospital, at this time of great need. Commenting on the Confidential Inquiry report, Marjorie Wallace, Chief Executive of SANE, said: "The report reveals the shocking and unnecessary waste of 256 lives a year for the last five years, every one of which was preventable." "Most disturbing is the numbers of people who commit suicide in the first few days and weeks after discharge from hospital, at a time when they should be receiving the highest level of care and supervision. Too many patients are suddenly catapulted into the community and left unsupported and often isolated. There is no excuse for the mental health services continuing to abandon people at the very time when they are known to be most at risk." SANE wishes the reforms of mental health law and services to bring back the lost concept of asylum, a place for someone to go, in hospital or in the community, when a higher level of support is needed.
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