Care in the Community

28/05/12 07:24 [Monday]
Last October I wrote a blog entry which for many months was on my front page at colinbrough.co.uk, saying that I regretted the fact that I was not being looked after in an asylum of the old type. This view I had derived from the medication I was then on, at a higher dosage than now, making it virtually impossible for me to do things for myself and specifically I mean things related to looking after the bungalow I live in. The first thing to say here then is that prescribing psychiatrists are not at all aware of the effects which the drugs they use can have and of the need to tailor the dosage with exceptional care.
The past two or three days I have been feeling bored - something I never felt when not on medication - and have been looking up details on the internet of the history of the former County Asylum system now replaced by the system of ‘care in the community’.
‘Care in the community is a failure’
Reflecting on the fact that the reason I myself might have needed to be looked after in an institution was medication prescribed at an inappropriate dosage, I ask myself if there are others who cannot cope for reasons in their nature. I refer readers to this blog and note the writer although seeming to be distressed by what I may summarise as over-responsivity states that to be ‘locked up’ would make matters worse. The basis of that of course is that she would be taken away from familiar things and would over-respond to a new and alarming context. This fact would not apply if she were given a home in an asylum year after year.
I have come across an article from the British Journal of Nursing which would please Conservative thinkers as lauding the old way of doing things this including effective charity provision:

British Journal of Nursing, 2011, Vol 20, No 22: Article by Diane Carpenter (Extracts)

• Abstract: This article outlines the asylum building programme of the mid-to-late nineteenth century and focuses on case studies of the two Hampshire asylums built during this period, the subject of the author’s doctoral thesis. It demonstrates the plight of ‘pauper lunatics’ before asylum reform and contrasts this with the improved quality of life provided by the Hampshire County Lunatic Asylum and the Borough of Portsmouth Lunatic Asylum respectively. Asylum care during this period followed the moral treatment regime which became the Victorian blueprint for mental health, components of which are illustrated. Criticism of this regime is addressed briefly and arguments are made against anachronistic analysis. Comparison with contemporary in-patient care and treatment is made concluding with a call to reconsider some of the better aspects of earlier care delivery. The particular experience of patients in Hampshire asylums at Christmas is used to exemplify the points raised.
• Charles Dickens, 1852: ‘There were the patients usually to be found in all such asylums among the dancers... Among them, and dancing with right good will, were attendants, male and female -- pleasant-looking men, not at all realising the conventional idea of “keepers” -- and pretty women, gracefully though not at all inappropriately dressed, and with looks and smiles as sparkling as one might hope to see in any dance in any place. Also, there were sundry bright young ladies who had helped to make the Christmas tree; and a few members of the resident-officer’s family...’
• From annual report Borough of Portsmouth Lunatic Asylum 1884: ‘The patients’ amusements continue as before. Dances are held weekly; and concerts and other entertainments at short intervals. Last January, 100 patients visited the Portsmouth Theatre Royal, by the kind invitation of Dr. Boughton, who presented each one with a book of words. Mr. White kindly supplied conveyances to take them there and back... On Christmas day, by the kind liberality of the Hon. Alice Baring, every patient had a Christmas card given to them. Some, who had also been patients here, sent small presents of apples, oranges, etc.’
• KEY POINTS: Moral treatment was a blueprint for mental health during the Victorian era and was based upon good diet, exercise, fresh air, adequate clothing, meaningful occupation, entertainment and an aesthetically pleasing environment as well as good relationships with staff; Current mental health care could usefully revisit the best that asylum care offered; Criticism of the asylum period is often anachronistic, failing to take adequate account of the historical context.