‘Unfinished care revolution’ lets disadvantaged groups down

The “unfinished revolution” of care in the community has failed the most disadvantaged people in society, according to a report.

The Centre for Social Justice report says that the changes in care, which abolished the distinction between psychiatric and other hospitals, are flawed.

As the government embarks on a wholesale shake-up of care, the report warns that a lack of services in the community means that resources are still directed to hospitals which are “untherapeutic and dangerous places”.

Paul Burstow, the Liberal Democrat social care minister, will attend the launch of the report, Completing the revolution – Transforming mental health and tackling poverty. It is published by the Centre for Social Justice, the thinktank founded by Iain Duncan Smith after he pledged to champion the vulnerable after he lost the Tory leadership in 2003.

The report says that the changes in care, dating back to the 1959 Mental Health Act which abolished the distinction between psychiatric and other hospitals, are flawed because they did not lead to an expansion in community-based services.

Dr Samantha Callan, chairman of the CSJ working group on mental health, said: “Care in the community was a classic 1960s piece of policy-making. The underlying assumptions were good – that the mentally ill were being dreadfully served by asylums that not only dated back to Victorian times but also Victorian attitudes – out of sight, out of mind.

“But the closure of the old mental hospitals was not accompanied by a parallel expansion of the full range of community-based services necessary to transform outcomes. Mental health care is a Cinderella service with a paucity of properly qualified doctors, nurses and psychiatrists.”

The report has harsh words for hospitals. “Money is still tied up in in-patient care because the services people need are not available in the community. Hospitals tend to be untherapeutic and dangerous places.”

The report notes that disadvantaged groups suffer disproportionately. It says less affluent groups in society tend to be “more at risk of being exposed to traumatic events and more vulnerable to the effects of such trauma”.

The report adds: “The better-off have been more able to take advantage of the increased health investment than the less well-off, contributing in extremis to the creation of a disadvantaged ‘underclass’ at the margins of society, whose members have a sense of fatalism, and a loss of autonomy and resilience. Primary care provides valuable opportunities to build in a preventive approach that will promote mental health and not leave any group of people behind.”

Care for black and minority ethnic communities is seen as a “major faultline in mental health”. The report stresses that it would be wrong to regardBritain’s BME communities as homogeneous.

But the report says: “There is much common ground due to the fact that disadvantage and discrimination significantly affect mental wellbeing and mental health, and BME communities in theUKare generally agreed to be exposed to higher levels of such experiences. These are then further compounded by the stigma relating to the development of mental health problems.”

The report calls on GPs to show greater respect for Black Voluntary Community Sector (BVCS) which involves lay people. It says: “We recommend that GPs work more closely and respectfully in partnership with the BVCS.”

The report concludes that the government’s health reforms, enshrined in the health and social care bill, provide an opportunity to mental and physical health provision. But it says: “Primary care will have to maximise the unique contributions of voluntary and private providers. Forming strong, properly resourced partnerships is vital but the current funding ‘playing field’ is tilted against them and towards statutory services.”

Callan calls for a more flexible approach with less reliance on the state. “It is time, using the reforms in the Health and Social Care Bill, to open up mental health services to contributions from charities, private providers and community groups so that we can complete the revolution in thinking dating back to the 1960s.”