ABSTRACT
The implementation of the policy of community care for the mentally ill, which has been government policy since the 1962 Hospital Plan was launched, was supposed to herald a new, more humane era in the treatment of the mentally ill. The overall plan for mental health care included short-tenn treatment in district general hospitals and outpatients departments, (a provision similar to that offered for any other illnesses), and also the provision by local government of a network of hostels, day care centres, sheltered workshops and social work support for the chronically mentally ill. However, the rationale behind this new approach was influenced by a variety of factors, and not motivated purely by the desire to improve life for the mentally ill; these included the acknowledgement of the appalling conditions in some 'asylums'; the work of Goffman and others, which argued for the deleterious effects of institutionalisation on the individual; the advent of anti-psychotic drugs, which for a while appeared, according to the psychiatric profession, to offer 'cures' for mental illness and certainly enabled more people to cope with life outside an institution, and, not least, cost. It combined idealism and the desire to cut costs:
By bringing the [mentally ill) back into the community, by enlisting the goodwill and the desire to serve, the ability to understand which is found in every neighbourhood, we shall meet the challenge which such ... persons present ... and at the same time ease the financial burden of their confinement in fixed institutions. (Alper, 1973, pp. vii-viii)
There were thus some unlikely bedfellows united in arguing for a policy of community care to be implemented and this has been an underlying cause of some of the chaos that currently surrounds its implementation. It must also be acknowledged that Alper's vision of communities seems to be based on a Utopian fantasy rather than reality. The chaos has been exacerbated by the confusion surrounding the definition of 'community care'. The term appears along with the tenns 'de-hospitalisation', 'de-institutionalisation' and 'normalisation' throughout the literature on contemporary mental health care; these terms are frequently used interchangeably, yet they are rarely defined. Chameleon-like, they take on
whatever meaning a particular author chooses. Bachrach, considering the term 'de-institutionalisation', gives a sample of meanings from professional and popular literature which includes:
moving mental patients from enormous, remote hospitals into small community residences
a euphemism for official cruelty
a synonym for "homeless"
[a term that should be replaced by) "transinstitutionalisation" to indicate that "the chronically mentally ill patient had his locus of living and care transferred from a single lousy institution to multiple wretched ones".
