If you live in the UK you must have noticed a massive increase in homelessness, in particular homeless people with drink and drug problems. Durham has a hardcore of about 20, sometimes the police and the council get them off the streets, but a few weeks later they are back again. Some are vulnerable and mentally ill, some are chaotic drink and drug users.
Recently the Government announced £3.2m funding to the NHS to help address homeless people with mental health problems.
Frankly this is stupid and insulting.
To understand this we need to go back to the 1980s. The then Thatcher Government led a massive reform of the NHS, in order to encourage more private sector involvement. Management costs doubled, and the internal market was introduced.
Sir Roy Griffiths, CEO of Monsanto, was asked to review long stay mental hospitals, he produced ’Community Care: Agenda for Action’, which recommended the closure of all long stay beds. In future these patients would be cared for in the community.
From 1988 onwards 100,000 patients were discharged. The central problem was that the community services to treat these patients didn’t exist.
Vulnerable people rapidly lose contact with services, self medicated with drink and drugs, and often became homeless. Every major UK city acquired a group of former long stay patients, homeless, and drinking and taking drugs publicly.
Once these groups of homeless took hold they would start and attract others, who weren’t mentally ill, but who were chaotic drink and drug users, who gravitated to these communities of mentally ill, sometimes preying on them.
The Government did little or nothing to deal with these groups other than making moralistic speeches. They didn’t spot that there was another group that was been drawn into these chaotic communities – Dangerous Severe Personality Disordered Offenders. These individuals preyed upon the vulnerable and lost, and I don’t think anyone knows how many homeless were murdered or abused.
The police and authorities showed no interest until December 1992 when Jonathan Zero was killed outside a London Underground Station. It took the death of someone who wasn’t homeless to wak up the authorities.
Even then progress was slow until Labour came into power in 1997. In 1999 Department of Health introduced the first National Service Framework for Mental Health. This introduced the idea of Assertive Outreach, specialist teams who made contact with people who were disengaged with services, homeless and vulnerable.
I was responsible for implementing the NSF locally, which is how I ended up interviewing a burly CPN for a role leading the local Assertive Outreach team.
“Can you handle this job?”
“Me? Yeah. I spent 5 years in ‘Nam”
“Nah, mate, Tottenam”
The then Labour Government backed the NSF with real investment. £750m over the first 3 years, plus £120m one off funding for capital and implementation, crucially allowing local areas to set up new services before they closed the old ones. By 2005/06 Mental Health funding had risen 47% in real terms compared to 1999. Local Authority spending on mental health services increased by 30%.
This was the biggest ever increase in Mental Health Services funding in UK history, in fact I don’t know any other country who made such an ambitious investment.
And it worked, outcomes improved, and mentally ill homeless people were taken off the streets. With them safely housed sorting out the chaotic and the dangerous was much easier. The spectacle of drunk, drugged homeless people on street corners vanished. A Dangerous Severe Personality Disorder programme was set up to deal wth the small number of very dangerous people who fell between NHS and DOJ.
Some of these individuals had happy endings, they re-engaged with services, their health improved, they re-integrated into society. Some, sadly, were too badly damaged – the best the NHS could do for them was help to ease their symptoms, and get the securely housed. Some of them still drank and took drugs, but did so at home, and were no longer a risk to themselves or others. They were housed, they had access to benefits, even if they weren’t getting better.
And then 2010 happened.
By then I was working for DWP, and saw close up the new agenda for benefits. Ian Duncan Smith increased sanctions for people who weren’t compliant and increased targets for claims to be rejected. The most vulnerable were easy targets, and too often it was the mentally ill who had their benefits stopped. They were horrified that the NHS had housed, and organised the benefits, of people who were doing very little to justify those benefits.
The decade of hard work, and the £100ms spent were thrown away to try and reduce the benefits bill, a plan that ultimately failed.
I did try and discuss in DWP how short sighted this was, how likely it was that they would cause huge harm to individuals, and that any savings would be eclipsed by the additional costs to the NHS and Police, and the increase in homelessness.
But no-one was interested. Headlines in the Mail and the Express were the priority, and long term damage wasn’t considered – the horizon for policy announcements was never further than the next days papers.
At the same time funding for mental health services fell by nearly 10% in real terms. Assertive outreach teams are still there, but their funding has been slashed, and the services that they rely on like housing and benefits advice have been slashed too.
And the results of this are for all to see. Once again street corners are full of a predictable mix of the mental ill, the chaotic and the dangerous.
The promise of £3.2m is frankly an insult. A decade of work trashed, lives destroyed, for no reason other than a failed ideology.
And trust me, after the £3.2m is spent the tragic, and the chaotic and the psychopathic will still be on the street corner.