Letter: Conflicts in inner-city health care

Sir: Marianne Macdonald's article 'Sharon Dalson - a tragedy they watched happening' (8 January) seems a most thoughtful summing-up of the tragedy of psychosis in a young mother, but perhaps your reporter is unaware of the widespread nature of this problem. As a psychiatrist working in inner London, I regularly come across women suffering from psychotic illnesses whose ability to cope with their children varies considerably.

We recently admitted a mother, rescued from a fire, which she had set, in a catatonic state, and having been luckily extracted along with her two children (who had nooses around their necks) by a watchful neighbour.

The problem is a particular variant of the wider problems of community care in deprived urban areas. Monitoring mental health is a professional job, yet social work and community nursing staff are poorly resourced. Furthermore, the usual division between children's teams and adult teams can result in a gap in responsibility. Conflicts arise as to whether the main problem is 'mental health' or childcare ability. Such demarcation may seem pettifogging to outsiders, but again derives from the appalling pressures under which inner-city teams are operating.

The mother described above has now been satisfactorily resettled, and is very well, having the support of three workers for her and her family. Unfortunately, this is in a suburban district, not the inner city, where asking for such manpower would be regarded as a sign of mental illness in itself.

As the Mental Health Act Commission has pointed out, inner-city psychiatric care, whether in the community or hospitals, is under siege.

Of course, many good practices go unreported between the scoops of the boy in the lion's den, the Zito case, and now this latest tragedy. We can expect many more, sadly, and I pity the poor children.

Yours sincerely,

T. H. TURNER

Consultant Psychiatrist

Hackney Hospital

London, E9

10 January