Leading Article: Cruel care for the mentally ill

IN ANGER lies hope. It has long been known that mentally ill patients are liable to kill others as well as themselves. The Royal College of Psychiatrists has now quantified this toll: 34 homicides in three years. The public reaction has been one of horror. Therein lies the best hope that proper action will be taken to correct the failure of community care in this field.

Public concern arises partly from genuine fears of being killed by a crazed stranger, as was Jonathan Zito last year. In reality, that danger is exaggerated. The RCP report identifies only two victims who were unknown to their attackers. Most were relatives or acquaintances. Those figures give some sense of the domestic violence that families and friends sometimes endure when living with people who are mentally ill.

The Government cannot shirk the implications of this report. All those who killed had been in the care of psychiatric services within the previous 12 months.

Two groups of patients slipped through the net. One, to which little attention has been paid, consisted of seven women, six of whom killed their young children, mainly during bouts of depression. It is clear that midwives and health visitors need to be more alert to signs of depression in mothers, particularly those with a history of such illness. But the system's main failure has been in maintaining the well-being of male schizophrenics. Broken connections between the NHS and social services are well- documented, the issue is how to fix them. So far the Government has tinkered. The creation of supervision registers for outpatients at risk, and guidance on follow-up after discharge from hospital, are a step in the right direction. Yet experience shows that as patients in the community become sicker, they miss appointments, fail to take medication and consequently receive less and less care.

An overhaul of the 1983 Mental Health Act is required. First it should be made much easier to bring uncooperative patients back for a spell in hospital until they recuperate: at present re-admission is too bureaucratic. Second, a new act should create a legally binding order making a clearly identified institution responsible for guaranteeing housing, jobs, social support and medical care for mentally ill patients at risk.

These measures would require the Government to provide more resources and district purchasers to make good their underfinancing of psychiatric services. Only this commitment will reduce the shortage of hospital beds, hostels and homes for the mentally ill. Without that, community care for the mentally ill is in danger of becoming an ever more cruel joke.