Psychiatric Hospital Closure: Myths and realities PDF
Preview Psychiatric Hospital Closure: Myths and realities
Psychiatric Hospital Closure 'When someone died here, the bell used always to ring .... When it rung, everyone said: 0, God, please let me die, as I am tired of continuing this life inside this place .... There was nothing to do, because they found themselves closed here inside and had no hope of getting out. It is like a plant fading because it did not rain and the leaves wither, this is what people here were like'. Andrea, in the Psychiatric Hospital of Gorizia, L'istituzione Negata, Einaudi, Tarin, 1, 1968. Psychiatric Hospital Closure Myths and realities Edited by Shulamit Ramon Senior Lecturer Social Work and Course Director Mental Health Work with the Continued Care Client London School of Economics UK Springer-Science+Business Media, B.V. First edition 1992 ©Springer Science+ Business Media Dordrecht 1992 Originally published by Chapman & Hall in 1992 ISBN 978-0-412-42980-4 ISBN 978-1-4899-7142-5 (eBook) DOI 10.1007/978-1-4899-7142-5 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication data available Contents Contributors vii Acknowledgements viii Preface ix Introduction xii The context of hospital closure in the Western World, or why now? xii PART ONE The experience of planning 1 1. The changing perspective of a resettlement team 3 Tony Wainwright Introduction 3 Historical context 4 Establishing a team and a strategy 11 Hospital to houses and private placements 27 Resettlement team involvement in other service developments in Camberwell 41 Progress review 42 2. Planning after a closure decision: the case for North East Thames Regional Health Authority 49 Dylan Tomlinson The context 49 The beginnings of closure 51 The conceptual and moral underpinning of the planned closure 59 Interprofessional and inter-agency conflicts 64 PART TWO Being at the receiving end of the closure process 83 3. The workers' perspective: living with ambiguity, ambivalence and challenge 85 Shulamit Ramon A note on available evidence 85 What is professionalism? 86 Health-related professions 88 vi Contents Mental health workers and professions: sources of ambiguity and ambivalence 91 Hospital closure: issues for professional workers in the hospital 96 Making sense of the experience of closure: a case study of social work teams 109 Summary 118 4. The experience and perspectives of patients and care staff on the transition from hospital to community-based care 122 Christine Perring Introduction 122 The psychiatric hospital: from sociological critiques to the patients' viewpoints 132 Selection and preparation of the patients to leave hospital 137 Transition 145 Living in a group home 152 Re-evaluating the past 163 Summary and concluding points 164 Conclusions 169 Emerging issues of concern 169 The bid for new control mechanisms 175 The reconsideration of main intervention strategies 177 Training for the future 179 Appendix A 184 The policy context 185 The legislative context 187 The emerging partners in the British scene 190 Contributors Dr Christine McCourt-Perring is a Research Fellow at the Department of Government, Brunei University. An anthropologist by training, she is active in the Islington Forum. Dr Shulamit Ramon is a Senior Lecturer in the Department of Social Administration, the London School of Economics - a social worker and clinical psychologist by training and author of: Psychiatry in Britain: Meaning and Policy (Croom Helm); editor and contributor to: Psychiatry in Transition: British and Italian Experiences (Pluto Press) and Beyond Community Care: Normalization and Integration Work (Macmillan). Dr Dylan Tomlinson is Research Sociologist, Team for the Assessment of Psychiatric Services, North East Thames Health Region. He is a political scientist and sociologist by training and author of Utopia, Community Care and the Retreat from the Asylums (Open University Press). Dr Tony Wainwright, Principal Psychologist, Camberwell and Maudsley Health Authority and Co-ordinator of the resettlement team of Cane Hill hospital. He is a clinical psychologist by training. Acknowledgements I would like to thank past and current residents and workers in psychiatric hospitals who have struggled with those institutions and thus have greatly contributed to our understanding of what needs to be improved in our mental health services and in our society. The other contributors to this book have been generous in sharing their ideas, tolerant of my intrusion into their hectic schedules, and enthusiastic about the project to which they have brought considerable experience and knowledge, turning working together into an enjoyable experience for me. Jo Campling continued to offer advice and support whenever required, despite all of her other commitments. Aelita suffered long weekends of maternal neglect with the genuine relish of a teenager and yet has developed an interest in mental health issues: I therefore dedicate this book to her. Preface A major British parliamentary committee on mental health services for adults commented in its report that 'any fool can close a hospital' (Social Services Committee, 1985). This book illustrates that even the wisest person would have found the task of closing a psychiatric hospital most complex and demanding, yet challenging and exhilarating at the same time. That this committee of eminent parliamentarians, which has listened carefully to the evidence of many witnesses and read a lot more on the subject matter, would thus conclude its deliberations, highlights the emphasis on services in the community to the point of being unable to focus on hospital closure in its own right, instead of being treated as an insignificant step towards a community mental health system. A different message is proposed in this book. The text demonstrates how crucial is the process of hospital closure for both the outcomes of such closure, as well as for the future services in the community. In a number of ways future services are defined and planned as part of the resettlement component of hospital closure, a point illustrated time and again in each chapter of this book. A British psychiatrist whose intelligence and knowledge I greatly value has recently reacted to a suggestion to focus on hospital closure in a professional journal by stating that this would have been relevant in the 1980s, but not in the 1990s. The lack of any research or current discussion as to what has happened in the massive closures of North American hospitals in the 1960s and the 1970s would indicate that, there too, professionals do not see such closures as related to their present services and their dilemmas. This book highlights that, unless we are able to understand the full impact of hospital closure on the direct and indirect participants in this endeavour, we as societies, countries, and people will be unable to connect our psychiatric past to our psychiatric present and future, and consequently unable to learn some most valuable lessons. Moreover, in many western countries the process of hospital closure has only started, with Second and Third World countries still aspiring to build large psychiatric hospitals. It would therefore seem that, far from being a matter of a long forgotten past, this is very much an issue of the present and of the future.
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