Mark Rudman
Mark talks about the coming of care in the community

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You come to the late 80s and the decay had started to set in. Community care had supposedly started up, and so there were a lot of mergers of wards, a lot of people being moved from one area to another, a lot of people being supposedly rehabilitated into the community. Whatever the reason for people having been admitted to the hospital in the first place, that may have been decades previously for some, that initial reason had passed and the predominant problem really was one of institutionalisation by then. Having said that, I had nothing but respect for the people that managed to survive the system.

There was a particular day that I recall. I was by the front entrance to the hospital, in its day a very grand entrance with a sort of flower bedecked roundabout in the middle and the driveway in, and the old clock tower, and that type of thing. They had these rather, arguably patronising, trips out, part of the rehabilitation - ‘Let’s herd everybody onto a bus, and take them all to the seaside for the day,’ and the particular day I remember, was, they pulled the bus in and they opened the rear doors of the bus to allow them to get the wheelchairs in up the lift for those that were in wheelchairs. As they led the people onto the bus, somebody said, ‘Could you pass down the rear of the bus, use up the seats,’ and they did - they passed down the bus, got off the rear doors and went back to the ward that they’d come from! ’Cause they didn’t want to go, did they. I just thought it was marvellous, they just sort of - my esteem for them just went up because they knew their own mind. They didn’t want to be herded around in a bus, you know.

When people talk about community care, the usual image in the lay person’s mind is of re-housing the former long stay patient and all the various connotations that went with that. Of course the bulk of real community care is about helping people in the community without having them admitted to a mental health unit. That, that’s the - you know - the key to community care. I think it’s just important to demolish that myth a little bit, and again today most people with a mental health problem will not see a mental health unit. Probably something like 2% of people with a mental health problem will finish up becoming inpatients. Most people are treated by community mental health teams, crisis intervention teams, home treatment teams, early intervention teams and so on with a view to keeping people involved in their ordinary day-to-day lives.