Abstract
DEAR SIR,
Congratulations to Holmes et al. for daring to point out that some patients fail ‘in the community’.[1] Congratulations also for thinking of a suitable name for the problem: community treatment resistant disorder. Perhaps, now, the policy officers will be able ‘to get a handle on it’.
“No army can withstand the strength of an idea whose time has come”, said Victor Hugo (1802–1885). This was the case with ‘deinstitutionalization’. However, because an idea's time has ‘come’, does not mean it is the best, or even a good idea; it just means the idea will (for a time, at least) have some ‘traction’.
The forces which led to the almost total closure of long-term secure care beds around Australia, and who was ‘to blame’, is debateable. The horse bolted 30 years ago, so no good would come of an inquisition. Certainly, those of us with passable clinical skills always protested that such beds continued to be needed.
A pressing need for more long-term secure beds is felt around Australia.[2] This need is about to evolve into an idea whose time has come (and happily, this one will coincide with common sense).
The word ‘institution’ has many applications, always incorporating order and regulation and, usually, custom and practice. Prominent institutions include the US Congress, the Roman Catholic Church, the Bank of England, the fish and chip shop on the corner, and marriage and family. Community treatment is as much an institution as were the psychiatric asylums. Like football teams, there were successful and unsuccessful asylums.
Some patients need asylums in some form. If the asylums of yesterday had the benefit of the spin-doctors of today, we would still have them.