Success of community care?

There is debate regarding the success or otherwise of community care. The evidence deriving from the closure of Friern Hospital on which the Team for the Assessment of Psychiatric Services project is based, discussed by Leff (2001), cannot be generalised because, in contrast to typical hospital closures, in the region of £100 million was allocated to ensure the ‘success’ of the project. Despite this expenditure, the following points should be considered. At the time of the closure of Friern Hospital an internal audit found that only 14 long-stay patients were there by compulsion and 11 of those were under court orders (Weller, 1989). After closure, high wire netting was erected and 24-hour guard-dog patrols were instituted because of attempted returns by patients to the hospital. Many of the patients offered ‘a home for life’ were subsequently moved. Many have become ‘revolving-door’ patients. The hospital building, of listed architectural merit (but which drew inexplicable opprobrium at the time), and spacious grounds are now luxury flats, and a £400 million deal has been struck for many more on other hospital sites (The Times, 12 September 2002: p. 3). Twenty patients committed suicide in the first year after closure (further details available from the author upon request). This figure stands in contrast to the findings of Powell et al (2000), who showed that even within the high-risk group of inpatients, 100 patients would need to be detained unnecessarily in order to prevent one suicide.