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Perceived failure of community care

Published online by Cambridge University Press:  02 January 2018

E. Hoencamp*
Parnassia Psycho-Medisch Centrum, Monsterseweg 83, 2553 RJ, The Hague, The Netherlands
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Copyright © 2002 The Royal College of Psychiatrists 

In his editorial on care in the community, Julian Leff (Reference Leff2001) describes processes comparable with those in The Netherlands, resulting in a call for ‘increasing restrictive mental health legislation enacted by governments pandering to public misperceptions’. This may be an indication that this process is more universal and not restricted to the situation in the UK. A few points may lead to more ‘perceived failure’ if not addressed.

Dr Leff states that ‘there is substantial evidence of considerable success… of the 130 psychiatric hospitals… in 1975, only 14 remain open, with fewer than 200 patients in each’. Does this imply that it would have been a failure if it were 25 hospitals with 300 patients each? Closing hospitals should not be a goal as such, but a means to provide better services to patients. That a new generation of psychiatrists ‘not only have never worked in a psychiatric hospital but have never seen one!’ may not be such a desired development. In the coming decades in-patient facilities will still be needed and the number of them may fluctuate because of new treatment modalities and the capacity of society to harbour patients. An increase or decrease should not be an indicator of success or failure at all.

The ‘invisibility of a community service’ as grounds for ‘perceived failure’ is interesting in relation to the statement that ‘the architectural presence of the asylums has been replaced by an apparent absence’. Were many asylums not tucked away at the outskirts of the city, if not further away? Mental health care should make itself, and its diversity of services, more visible. Could it be that professionals, patients and relatives have a somewhat defensive stance regarding the public and the media? In The Hague after the merger in 1999 of all psychiatric hospitals, community mental health organisations and addiction organisations, posters were put on trams and bus stops leading to a high visibility, which was well perceived.

Would ‘a comprehensive community psychiatric service catering to all the needs of the catchment area population’ enhance the perception of success? In The Netherlands in recent years this development has started in some areas owing to large-scale mergers of mental health organisations. This has lead to a disappearance of administrative and financial boundaries between in-, out— and day-care patient services. In The Hague there are indications that the needs of patients, family, general practitioners and police are better identified and addressed, leading to a visible profile and higher perceived success.

If we want to know what our targets are in ‘a public relations job of this kind’, we are at the brink of a more fundamental shift of defining and positioning the concept of (community) mental health. Who can identify him or herself with a psychiatric patient? Are there not fundamental differences between a patient with schizophrenia, agoraphobia or bipolar disorder? In The Netherlands generalisation and stereotyping lead to the situation that the acts of one person with an addiction and personality disorder may damage the positive image of mental health in general for a certain period.

Community-oriented care is a success for a subgroup of patients with psychiatric disorders. Perceived failure in one area should not lead to a situation that the whole of mental health services, including care in the community, is perceived as a failure.




Leff, J. (2001) Why is care in the community perceived as a failure? British Journal of Psychiatry, 179, 381383.CrossRefGoogle ScholarPubMed
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