Letter: Psychiatric services that can serve the community

Sir: The biennial report by the Mental Health Act Commission only confirms what was already known to mental health workers, users of psychiatric services and relatives and carers: acute psychiatric care in inner cities has been in a state of crisis for some time.

However, as Professor Elaine Murphy remarks in your report ('Crisis in hospitals over the mentally ill,' 11 December), the situation is not entirely due to lack of money. The serious problems in inner-city psychiatry are due, at least partly, to professional inertia in developing appropriate services that meet the needs of the local community. Our preoccupation with control and coercion, at the expense of care and support, especially when dealing with the biggest client group in our inner cities, also contribute to the difficulties that we now face.

Given the disproportionate numbers of black and ethnic minority patients who are caught up in a cycle of control through repetitive admissions to hospitals and secure units, with inadequate and often inappropriate care in the community in between, there are compelling reasons to consider alternatives to in-patient psychiatric care and work towards a model of community-based support.

In Birmingham, the Home Treatment projects that have been set up in Sparkbrook and Ladywood, both highly deprived inner-city areas with substantial ethnic minority populations, have clearly shown that up to 75 per cent of those who are seen as requiring hospital admissions could be diverted from in-patient care.

Our Home Treatment Service in West Birmingham has been particularly successful in offering an alternative to psychiatric wards. We have shown that the mental health crisis that usually leads to in-patient care can be effectively managed, in the majority of cases, to the satisfaction of clients and carers, without recourse to hospital admission.

It is time for the professional bodies, local service providers and the Department of Health to prioritise such initiatives, especially in our inner cities, if the current crisis is to be tackled effectively.

Yours sincerely,

S. P. SASHIDHARAN

Consultant Psychiatrist

West Birmingham Home Treatment Team

The University of Birmingham

Handsworth, Birmingham

13 December