The "unfinished revolution" of care in the community has failed
the most disadvantaged people in society, according to a
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
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
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 regard Britain'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 the UK are
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