I read Matt Muijen's article (Community spirit, pages 18-19, 27 January) on the appalling conditions of some psychiatric units with great interest, having recently helped a friend gain admission to one.

We first went to our local district general hospital's accident and emergency department, in north London. After our initial consultation with a triage nurse we had a four-hour wait, observing the insulting way in which many vulnerable patients were treated by the reception staff.

When my friend was eventually seen he was ushered into the cubicle set aside for psychiatric patients. This room was filthy, with longcongealed blood on the walls (the floors were regularly swept, even during our time in the unit - presumably floors but not walls are specified in the cleaning contract). The room had two plastic seats but nothing else.

I left him at 3am when the psychiatric registrar told me he would be admitted, although to where was unclear. Next morning I was told A&E staff did not record the destination of patients transferred to other hospitals.

Several calls to possible hospitals yielded no clues, but eventually - after I had described my friend at length - a nurse recalled someone from the night shift mentioning that he had been admitted to the local psychiatric hospital. It was 24 hours after arriving at the first hospital that he finally obtained a bed.

The conditions were very similar to those Dr Muijen describes. The ward was mixed-sex, and the nurses spent all their time shadowing the female patients to prevent them either being sexually assaulted or exposing themselves.

There was not even a pretence that they were able to offer a therapeutic environment, and their role was entirely custodial. In some rooms there was a pervasive smell of vomit and urine, only partly obscured by the liberal use of air freshener.

Many commentators, including myself, have highlighted the need for greater understanding of how the NHS's clinical outcomes lag behind western Europe's.

But it is equally important to compare the process of care and the settings in which it takes place. My friend has now had experience of psychiatric hospitals here and in Europe.

There was no comparison.

I assume our political leaders are unaware of how some of their fellow citizens are treated at the beginning of the 21st century. The only way they might become so would be to make unannounced visits. Sadly, the prospect seems remote.

Professor Martin McKee