Community care 'failing miserably': Government adviser warns of 'incoherent' system. Rosie Waterhouse reports

COMMUNITY care for severely mentally ill people is 'dangerously fragmented', incoherent, unco-ordinated and underfunded, a former government adviser says in a report today.

The damning assessment follows a 10-month inquiry chaired by Sir William Utting, former Chief Inspector of the Social Services Inspectorate at the Department of Health. The inquiry team included senior figures from the health, social services, criminal justice and housing fields.

Their report says the system is failing miserably because of the lack of a comprehensive strategy, insufficient resources, diffused responsibility across agencies, lack of understanding of severe mental illness, and the pressures of organisational change.

Listing 38 recommedations, the report calls on the Prime Minister to initiate a comprehensive and integrated policy, adequately resourced, to meet the needs of the estimated 300,000 people with severe mental illness.

A Cabinet committee should be set up to co-ordinate and monitor government departments including health, environment, social security and the Home Office.

The NHS must ensure - and be able to prove - that the money saved from the closure of long-stay hospitals is re-invested in alternative services for the mentally ill.

Twenty-four-hour crisis centres should be established, and a national network of community mental health teams should be established by all health and local authorities, comprising nurses, social workers, occupational therapists, psychologists and psychiatrists, trained to work with people with severe mental illness.

The Community Care policy has been repeatedly criticised in reports by mental health charities, the House of Commons Health Select Committee, and most recently by the Royal College of Psychiatrists, which reported there had been 34 killings by discharged psychiatric patients over three years. But today's 76-page report, published by the Mental Health Foundation, is the most comprehensive and critical to date.

The report accuses government departments of pursuing their own, sometimes conflicting, agendas instead of working together. Care professionals fail to co-ordinate services, and no one is held accountable when tragedies occur.

As a result, the policy of successive governments to close the large mental institutions and care for more people in the community is failing to meet the needs of many thousands of vulnerable and sometimes dangerous people.

The inquiry team included Sir Peter Imbert, former Commissioner of the Metropolitan Police, Peter Smallridge, former president of the Association of Directors of Social Services and June McKerrow, director of the foundation.

The inquiry was set up last September because of growing public concern over cases of self-harm and harm to others caused by mental patients who were supposed to be receiving psychiatric care. The cases involving schizophrenics included Ben Silcock, who climbed into the lion's den at London Zoo, Christopher Clunis, who killed a man on a London Underground platform, and Erhi Inweh, who stabbed to death a voluntary worker in a hostel.

Calling for every patient to have a care manager and a key worker, responsible and accountable, the report says: 'Some services - particularly acute hospitals in inner cities - are under such pressure that proper discharge planning of any sort is an unattainable dream'.

The inquiry found there was no published estimate of the resources needed, and little accurate information on current government spending on mental illness. The Mental Health Foundation estimates there is a shortfall of about pounds 540m a year.

The report says the Government has failed to come up with a reliable system for tracking the funds released by the closure of long-stay hospitals. 'As a result it is impossible to prove whether money has leaked away from mental health services - but it is widely believed that this is what has happened'.

Responding to the report John Bowis, Parliamentary Secretary at the Department of Health, announced the Government would bring forward the paying of an extra pounds 4.4m to health authorities to provide more places in regional medium secure units this year. This would help increase the number of medium secure beds to just under 1,200 by 1996. Almost half of this would go to the two Thames regions where pressure on beds is greatest.

He said: 'We remain determined that a more rigorous approach and tighter procedures must be applied to community care and that the efforts of all government departments concerned must continue to be carefully co- ordinated. We also realise that for patients whose long term needs are being assessed, and for those who present a serious risk to themselves or to others, more places are needed which offer a degree of security and ensure the safety of the public'.

David Blunkett, Labour's health spokesman, said the report highlighted the Government's failure to protect those with severe mental illness and to protect the public. He accused the Government of 'sleight of hand' in reannouncing money that was already budgeted for.

THE MAIN RECOMMENDATIONS

The Prime Minister should initiate action to ensure a comprehensive and integrated policy, adequately resourced.

The Government should publish a single comprehensive statement setting out responsibilities of each agency and department.

The Department of Health should establish a national standard system of managing care to end the present confusion.

Every person with a severe mental illness should be assigned a care manager and key worker to ensure proper care and support.

The Government must ensure that savings from the closure of long-stay hospitals are reinvested in services in the community.