One of the biggest healthcare mistakes ever made in the UK was to close down the mental hospitals and instead treat those with mental illnesses in the community. Whilst there are indeed some people with minor mental conditions for whom treatment in the community would be appropriate, there are also those with catastrophic conditions who need to be detained either voluntarily or non-voluntarily in a hospital.

I’m old enough to recall the arrival of what was called Care in the Community in Britain during the 1980s but as a process Community Care didn’t start in the 80’s. The move away from hospitalisation was a long one. From the 1950’s through to the seventies with the arrival of new more effective psychiatric drugs the big, sprawling Victorian mental hospitals seemed to be falling out of favour with everyone from doctors to Health Ministers like Enoch Powell, decrying them as unfit for the modern world.

Eventually in the area of mental health treatment the idea that the hospitals should be closed down, the buildings and land that they stood on should be sold off and that patients should be treated by community psychiatric services, became a world wide fad. Unfortunately what happened was that too many hospitals were closed down and there are now not enough mental health beds for those who really need them. Putting people who need to be in hospital for mental health issues into community care has had devastating effects on both mental patients and the general society. Whilst the vast majority of the casualties of what is increasingly looking like a misguided policy of mental hospital closures are among the mad themselves, who take their own lives at a terrible rate, society also suffers when those who should be detained because their conditions can’t be managed outside of a hospital are left to roam free.

A good example of care in the community going tragically wrong can be found in a recent case from Birmingham UK where a man who should have been detained as he was a danger to others was allowed to live freely and without adequate supervision by mental health professionals. This latest care in the community tragedy resulted in a mental patient who in the middle of the last century would have been placed in a mental hospital, stabbing one man to death and seriously injuring a number of others.

Here’s the story. The original text is in italics where as my comments are in plain text.

A man who stabbed people at random, killing one and seriously injuring seven others, has been sentenced to life with a minimum of 21 years.

Zephaniah McLeod carried out the attacks within 90 minutes in the early hours of 6 September last year, as people were enjoying a night out in Birmingham.

CCTV and dashcam footage captured him walking calmly through city centre streets, stabbing people and moving

He was sentenced at Birmingham Crown Court.

The judge said the 28-year-old was a “significant risk” to the public and ordered him to be detained, initially at Ashworth psychiatric hospital.

All the victims of MacLeod were random individuals. None of them had triggered MacLeod into violence in any way. He just stabbed people because he could and was motivated by his twisted mind.

McLeod was suffering from paranoid schizophrenia at the time and was “well-known” to mental health services.

Truly this is a person who should have been in hospital. Maybe if he had been then these attacks would not have happened.

However, the judge said he got “lost in the system” after being freed from prison during the COVID lockdown in April 2020.

What an absolute mess. This is a man who was known to the mental health system since 2012 and who had a long record for violent behaviour. A sensible system would have discharged this man from prison directly into the custody of a psychiatric hospital but there now so few hospitals available for people like this that he was just let loose and expected to stay in contact with mental health services, services that are already grossly overstretched. What is bothering me is that this is a case of someone being released from prison during the first lockdown and not properly monitored by mental health professionals and I wonder how many more like MacLeod are still wandering around?

The court heard McLeod had been suffering with paranoid schizophrenia since 2012.

He had previous convictions for robbery, escaping from lawful custody, possession of a firearm in a public place and possession of class A drugs.

He had spoken to a psychiatrist on the phone on 3 September, days before the attack.

“On release from prison in April 2020, we were unable to make contact with him as we were not informed of his whereabouts. I spoke to Zephaniah briefly on the phone whilst he was with his care coordinator…” Dr Ezzine Onuba, the psychiatrist, wrote in a statement.

“Zephaniah continues to hear voices which he told me is there all the time and can be distressing.

“It was difficult to do a full assessment. He was due to be seen face to face on 24 September 2020.”

Between the phone contact with the psychiatrist on the 3^rd of September and the date when he was due to be seen face to face, MacLeod carried out these brutal and senseless stabbings. Maybe if he’d been seen and assessed by mental health professionals on release or at some time before September, then it’s quite possible that these attacks would not have happened. MacLeod would have either been stabilised in the community or better still confined to a hospital. The trouble is that he was not. He was allowed to remain unmonitored and presumably untreated and eventually went on to kill.

Care in the Community has been an utter and complete disaster for Britain’s mental health system. It doesn’t just mean that mad killers like MacLeod or those with the potential to kill are not properly confined or monitored or treated, it also means that people with distressing mental conditions who might be better off being treated in a hospital setting are all too often left to their own devices. These patients then end up with worsening conditions that can lead them to self destruction.

We are watching, with the abject failure of care in the community, the end result of a world wide fad for closing down hospitals that was promoted by medical professionals and politicians alike. This is not the result that we were promised but it’s the result that we have ended up getting.