Beds and stigma in mental illness  

 

"Psychoeducation is the most important weapon against stigma".  Well, I never.... I am somewhat underwhelmed by recent PC worthy observations on the genesis of stigma. Like most  I too favour virtue over evil. More seriously let me  suggest that the most potent force combating stigma in the public mind is the presence of speedy  accessibility to adequate inpatient facilities for the treatment of acutely mentally ill persons. It therefore seems odd that deficiency of properly staffed psychiatric bed numbers has not been more emphasised. It's a bit like that elephant in the room that isn't noticed. 

Let me make a submission  for your consideration; unfortunate acutely mentally ill patients cared for, more to the point inadequately cared for, in the community, wandering the streets, perhaps inappropriately accosting others; worse, maybe even with overt violence and peculiar utterances that separate him or her from the mindset of those around and sadly maybe even followed by the tragic spectacle of that person resisting compulsory admission to psychiatric hospital. Such, I suggest, is the most significant oxygen fuelling mental illness stigma.  

Psychiatric illness, no matter how hard we may wish it, cannot be airbrushed out of reality. Delayed admission is damaging to both that patient's prompt medical treatment and  procrastination, as the patient waits in the community for that bar-of-gold hospital bed, provides further fodder for stigma and more prolonged illness.     

In anything I have read (and there has been a fair amount) about stigma, I have seen little about hugely inadequate NHS inpatient facilities (the massive reduction in appropriately staffed hospital beds) militating against hospital admission for the acutely ill which leaves them in the community, inadequately cared for. The corollary of that  too often is that once in hospital, they risk premature discharge to "make a bed" for some unfortunate who is at that point even more in need of it.

Now the public, especially the metropolitan public in large cities such as London, because of  frequency of seeing persons with behaviour suggesting mental illness, has bred a street-wise response which quite consciously avoids eye to eye contact with others apparently exhibiting such behaviour.  And who can blame them when individuals like Jonathan Zeto, an unknown innocent bystanders, was stabbed to death a few years ago by acutely mentally ill stranger, outside a London Tube station.  I mention Jonathan Zeto-he is one of a number of high profile patients - mainly because his window Jayne inaugurated the Zeto Trust, an organisation  prodding government,  crusading, to create more inpatient places for the severely mentally ill. A worthy cause it is.  The psychiatric bed numbers shrank from 150,000 in 1955 to 41,800 in 1994.  And that is as recent as could be discovered in 1997. Within the profession the number is considered to have fallen further.  But modern politics is unique in these matters: never has there been more verbal tribute to transparency and yet so much opacity in accessing government information on bed numbers in the NHS. Now (Daily Telegraph Aug 27, 2002) the Liberal  Democrats claim that in response to their Parliamentary Questions they have discovered that 3,426 acute beds for the mentally ill have been lost since 1996-97 despite Government spin about their National Service Framework standards and their alleged extra funding.