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Social policy is a governments application for welfare development and social protection carried out in the community. The Margret Thatcher's conservative administration and Tony Blair's labor administration had different approaches towards the issue of community mental health care policy. The policy made vital steps towards the right direction but met obstacles on the way complicating its sustenance and achievement of desired goals. Generally it is believed that the policy did not meet its desired goals of helping the mentally ill patients in the communal setting.
Community care is the British policy of, deinstitutionalization treating and caring for mentally disabled people in their homes rather than in an institution or hospital. Institutional care was the target of widespread criticism prompting the government of Margaret Thatcher to adopt a new provision of community mental health care. This was after the Audit Commission published a report called making a Reality of Community Care which outlined the advantages of domiciled care (Baker, 1986).
Social policy is influenced by a number of factors that include needs of the population; demands from groups, priorities of the community, specific societal issues and critical incidents. The major intend of social policy on community care is to keep people in their homes where possible, instead of giving them care in other institutions. "It was almost taken for granted that this policy was the best option from a humanitarian and moral perspective. It was also thought that the policy would be cheaper" (Baker, 1986). Therefore this paper will focus on Margaret Thatcher's conservative government and Tony Blair's labor government to see how their different policy approaches have impacted upon the provision of community care of mental health. The paper will also be analyzing the advantages and disadvantages of both parties to ascertain where they have helped and where they have displayed poor services. Finally the paper will conclude by giving an insight on the impact of the current social policy on community mental health care.
Margaret Thatcher's administration and community health care policy
When Margaret Thatcher came to power in 1979, she made it clear that she would reduce public expenditure and make drastic changes for the betterment of the country. She was acutely aware that Britain's welfare state system needed urgent restructuring as it was costing the country too much money in the event putting the country into economic free fall. Between 1979 and 1990 she successfully introduced changes to social policy, the organization and delivery of services and the role of the state welfare provision. As a result the era became known as Thatcherism.
In 1983 the Mental Health Act was introduced by Margaret Thatcher's government to put in place safeguards for people within the hospital system. Section 117 of that act imposes a duty on district health authorities and social services departments in conjunction with voluntary agencies, to ensure that after Care service is provided for people after discharge from hospital.
The approach taken by the conservative government to social problems was known as the market liberalism or neo-conservatism, and this was very influential in the way it operated. Thatcher believed in having a 'market economy' allowing people to create their own wealth in the event taking care of themselves and their families without the interference of the government. This approach was evident in the health care and community care reform brought on board in 1990. The aim of this act was to standardize and improve community care and establish duties for the English Health Authority. This piece of legislations not only led the way in developing the new 'internal market' system in health and social care but divided the organization of care into "purchasers and providers of care" thus creating an artificial market to increase efficiency. It then caused a major development in the 1989 White Paper (Caring for people) as a response to the Griffins report. This was effectively putting the responsibility firmly at the doors of the health authorities and families thus freeing up more money to be put back into the system. However, due to flaws within the assessments, lack of funding and the failing of community care, people were being discharged into the community without proper supervision, care, help and support. As a result of this some individuals became homeless ending up on the streets while some are being cared for by overstretched family with financial difficulties.
Despite of the positive approaches on Margaret Thatcher's implementations she had some bad sides too. As a result of these policies, a number of changes started to appear in the society, where members of families who suffered mental health had to rely on children to take care of them, which consequently put burden on them causing isolation, social exclusion and to some extent extreme poverty. Because of these negative impacts and lacking of a proper system in place for home care (proper monitoring and provision of communal health care officials to treat patients at home), Margaret Thatcher's government was unable to adequately address the issue of community mental health care.
Community mental care act 1990
In the act passed in 1990 on community care health services (NHS ACT 1990), individuals with mental problem difficulties were able to stay at their homes while being treated. This state of affairs raised concerns especially after some individuals with mental health problems were involved in violent behavior against members of the public. Even though the community has recorded a few murder cases caused by people having mental health difficulties, it is more probable that healthy individuals can as well attack the mentally ill.
Mental Health is always portrayed in the media as negative but nothing has ever really been highlighted about the way people with mental ailments are being subjected to attacks and abused on a daily basis from the general public. It is sad to note that no one seems to take account of their plight, not even the government. So as much as this act made it possible for patients to be personally assigned specific community workers to monitor and take care of them, it posed a major risk in the community. These patients were under risk of being abused, attacked, neglected and untreated making the act look inefficient. Mental health patients eventually became uncontrollable ending up on the streets. These issues are usually prompting arguments between the public administration, health services officials and the department of social service on who should be held responsible of the whole matter. One such lack of help to detrimental effect was when Christopher Clunis, a mentally ill patient, stabbed and killed Jonathan Zito, an innocent person, in Finsbury Park tube station. This could have been averted had there been proper home care and supervision provided. These types of cases are common but there seems to be very little done to alleviate such tragedy.
There ought to be no contentment therefore in ensuring good quality community care for patients with mental problems. "The main challenges to the policy of the rundown traditional psychiatric hospital are the concern that homelessness is being increased among the mentally ill and the fear of public safety because of homicides by psychiatric patients" (Mathews, 2002). Other issues involve appropriate assignment of social workers who would take care and monitor these patients. Over the last few years activists in opposition to community care have diverted their aggression to the concern of public safety. These has prompted the government of Britain to put into practice a key review on mental health policy. It is also apparent that issues on public safety are the ones driving the review.
Tony Blair's government's approach on community mental health care
When Tony Blair was elected the people had high expectation that he would put in order the NHS system. Although he did not have any viable alternatives to the existing policies of Margaret Thatcher, he ridiculed them. He even used the same strategy to in his campaign resulting in a NHS historian, Charles Webster, calling it "the meanest spending package on the health service since the second world war". His promise to the people of the country was that he would not cause any structural upheaval to the NHS but he would carry out some reform which would be gradual involving consultation and experimentation.
Unlike the decentralization that Margaret Thatcher adopted in her era which was against the 'nanny state' mentality, the approach adopted by Tony Blair was that of a democratic society. Despite his belief that the government should play a greater part in monitoring what goes on in the society and intervene when necessary to ensure that fairness, he was tolerant with the idea of free enterprise.
It has now been a decade since Tony Blair's government vouched that they would tackle the NHS mental health service with vigor promising that equal priority would be given to mental health issues as that of heart disease and other ailments. This is what was stated by the then health secretary Frank Dobson in 1999. The National Services Framework for mental health 1999 (ten years plan) promised seven standards of care and treatment, these standards included primary care, access to services, prevention of suicide and caring about careers.
Regardless of this the labor government under Tony Blair made some changes within the health service. His successor Gordon Brown is worse as he has not made much with the NHS. He set his sight on more cuts and closures which effectively caused more damage to an already damaged NHS. He has not carried out the National Service Framework 1999 that had been promised by the labor government, so together they have failed to effectively implement the policies even though they have been in power considerably long. Their failures are also manifested further as the national frame work for mental health deadline expired last month and yet it still did not meet its targets. However the department of health announced a package of measures in January 2009 for the design and development of single sex accommodation within the health system. This will include a £100 million Privacy and Dignity Fund for improvements and adjustments to accommodations. The new initiative came into effect as of April 2010 which was a big step in ensuring privacy needs of male and female patients are fully met.
Still some changes have been made by the two previous governments and their respective leaders (the Margaret Thatcher's conservative party (1979) and Tony Blair's 1997 labor party), with regards to the implementations of the Mental Health Act 1983 the NHS and Community Care Act 1990, and the National Service Framework Act 1999. Even though it still appears that not much has been done to help especially members of the ethnic minority groups. There are still disparities in the way services are being distributed and how they are being treated as patients compared to their white counterparts. For example, they are discriminated against more and are more likely to be given higher dosages of anti-psychotic drugs or sometimes even put into seclusion.
The Community Care Act 1990 was put in place mainly as a cost effective measure, thereby moving people with mental health issues out of hospitals into the community. However, some people are still not receiving the necessary care that was promised by the government, although to some extent they are being empowered by being encouraged to be more proactive in their own assessment and care plans. Of late these provisions are ineffective as they do not meet the required specification.
The organization of health services concerned with mental problem was simple previously before the current NHS and social reforms came into play. The government was responsible of the NHS and controlled fund allocation, functionality, and supervision of these health services. Local government played a very small role in the care for mentally ill individuals, there main was in housing and social work sustenance. Initially, it was the responsibility of sanatorium community divide.
In the 1980s important reforms were made to both the NHS and social services. These reforms were largely aimed at changing the management arrangements for delivering general health care in the NHS and at reforming the community care of elderly people provided by social services. Little thought was apparently given to how the reforms would affect the care of mentally ill people. We believe that these changes, each of which on their own might have been valuable, have combined to damage provision of care, at least for severely mentally ill patients (Mathews, 2002).
Mental health policy defines the vision for the future mental health of the population, specifying the framework which will be put in place to manage and prevent priority mental and neurological disorders.
Therefore as shown in this paper the approach to the social policy on community care and mental health should focus on communal mental health problems and generate solutions for curbing these predicaments. The primary aim of this policy is to identify the most useful and efficient measure to successfully address these issues. On other hand the bringing of new policies in the mental health sector has totally transformed mental community care provision. "Simple systems have been replaced with complicated organizational and financial structures requiring almost impossible feats by local health and social service staff to coordinate care for patients to whom continuity of care is critical for their survival in the community" (Mathews, 2002). Critical mentally ill individuals are ensnared by these problematical issues. The formation of a community care authority that is localized which is accountable for the issue at hand could be the best solution.