Adult Social Care

Errata

EdInvestor wrote: »

Looks like the bottom line question then is when did the NHS close down the psychiatric hospitals?

Care in the Community policy which Mrs B refers to was the tool used to close down large hospitals which had been built as Victorian lunatic asylums with 1500 - 2500 beds in some, and settle the patients with a psychiatric health problem in their own homes in the community. These were a mixture of sole occupant homes, shared homes and intensively supported living homes for a group of people.

Closure took several years to accomplish and from the start no new patients with a diagnosis of dementia were accepted other than for rapid assessment to decide which care home (council or private) would be best for them.
Because of the length of time closure took many of the older long stay patients with dementia died before they could be moved to a care home.

From memory, the closures were completed towards the end of the 90's. Small psychiatric hospitals replaced them, with units for older people to be assessed. The aim is to have the older person settled in a care home within 13 weeks of being admitted to a psych unit for assessment.

HTH -I'm doing all this from memory; it's late and I'm a bit tired.

margaretclare

There is a small psychiatric unit in the little market town where I live and there is also a purpose-built new EMI unit in the next village, both under the NHS. We had a friend who was treated in both these a few years ago - he died in the EMI unit about 3 years ago.

The large psychiatric hospitals still existed up to the early 1960s - I was treated in one for postnatal depression in 1964.

Weren't there some well-publicised instances of women who'd lived in those large institutions for decades just for having an illegitimate baby? They were so institutionalised that they couldn't live independently, although there was really nothing wrong with them. You could be diagnosed 'mentally ill' with apparent ease in days gone by!

I mentioned 'Cathy Come Home' because IIRC in that film there was a mention of Part III accommodation being used for homeless people under the National Assistance Act 1948. The horror of anything reminiscent of 'the workhouse' and the evils of the old Poor Laws took a long time to disappear.

In the early 1980s my aunt spent her last few years living in a purpose-built, new council home, and it was a lovely place. She was physically, rather than mentally, disabled. The intention was that the residents should live in small units, like a flat with a small number of people living together, a 'family' atmosphere. They even did our Silver Wedding party for us (my first husband and me) just so that my aunt could be included and could enjoy it.

There used to be one similar to that near here but it closed down - the council couldn't afford it. But the idea had been to get right away from the old huge institutions that were like a small town in themselves, and 'humanise' the whole thing.

treliac

Ah. Was this called 'Part III accommodation'?

Yes - Part III of The National Assistance Act, 1948.


The Community Care Act, 1990, transferred further powers and responsibilities to local authorities.

Before the act, retired people could go straight to their DHSS office and claim the funding needed to pay for residential care. I guess it was the ever increasing demand for such funds that led to the implementation of the CC Act as that transferred funding over to local authorities and gave them the responsibility of assessing the needs of people requesting such care, before it could be funded.

Errata gives an overview of how the old asylums came to be closed and modern psychiatric care evolved.

However, quite how dementia care came to be rooted within social services rather than NHS services, I am unclear of although this would meet the changing philosophy of moving away from the hospital environment wherever possible. It's a continuing dilemma, with a feeling that the NHS has offloaded it's responsibilities in this area. Still open to challenge, I believe. Individual cases are assessed on their own merits rather than it being clear cut. Even though there are guidelines for continuing care, they are just that and open to mis/interpretation.

However, the needs of older people change and once an individual has become settled in any care home, it is right that they should remain there for as long as possible even when their needs, dementia or otherwise, have increased, provided the right level of care can be given to them. So the edges will inevitably be blurred.

Note - A main factor in this, for the government, is the fact that NHS care is provided free of charge, whilst recipients of most social services are assessed for their ability to pay for or towards their costs. It is also, of course, cheaper to employ care assistants than qualified medical staff.