The recent incident in which a social worker was stabbed in a hostel calls into question the government's plans to increase this type of provision as part of its 'third way' for mental health.
Health secretary Frank Dobson's proposals for ensuring 'safe, sound and supportive' mental health services, and the cash that accompanies them, are a welcome development.
Furthermore, at least some of these ideas are based on evidence about what works. Nevertheless, this is a long way from claiming these proposals are 'evidence-based' or that they will guarantee 'safety'. This is not a call for more research, but rather a plea to read some of the writing on the wall.
Sadly, this incident is not the first of its kind. Part of the media furore about care in the community for people with mental health problems included the case of Andrew Robinson, who also killed a female care worker in a residential setting. Therefore, while an increase in hostel provision may be appropriate for some people with mental health problems, we cannot assume it will, of itself, guarantee 'safety'. The extension of 24-hour services raises issues about cost and effectiveness that require justification.
This type of provision may be what people with mental health problems say they want, but where is the evidence this will make a difference to the safety agenda? Christopher Clunis, who achieved notoriety as a result of the failure of mental health services, was turned away during office hours. The lessons from the plethora of inquiry reports needs to learned.
Mental illness has been accorded priority status, with a national service framework and legislative reform on the way. But when will we have a mental health service which delivers quality, empowers service users and protects the rights of all concerned?
Lesley Cotterill, Dr Wally Barr
Health and community care research unit
Liverpool University
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