ethelbags Do you think a person with a mental illness or a learning disability would make a conscious choice to live in a filthy hovel and eat only pizza, or is it that some people are either temporarily or permanently unable to organise their lives without a great deal of support?
To my mind much of "care in the community" hasn't been as caring as it should have been. My husband originally worked as a nurse in large institutions for people with learning disabilities. The positive side was that the residents were reasonably well clothed, well fed, generally kept safe and had companionship. The downside was that those who would, with some help, have been able to live more independent and fulfilling lives became dependent on the staff because they didn't need to acquire new skills - everything they needed was catered for.
Care in the community shouldn't mean just plonking someone down in a flat somewhere, on their own, and popping in now and again to observe and record the ensuing chaos. I think the scheme where tenants can live rent-free in exchange for some basic support of a person with a mild/moderate learning disability is a good idea. Also, small units where one or two trained staff give help to residents to acquire new skills and to deal with everyday practicalities like shopping and budgeting.
I think unfortunately that the motivation behind closing these vast institutions was not altruistic but based on economic factors. Maintaining, heating and staffing those places cost a great deal of money and there was a further incentive to close them as the land on which they stood was often very valuable. There are many examples of the land and buildings on these sites being sold to developers for large sums of money, and the buildings either demolished or re-developed for luxury flats. The community provision that followed was sometimes excellent but more often cost-cutting left people with psychiatric illnesses alone and unable to manage their medication, their finances or basic practical tasks, which led to some of them ending up on the streets.
In the latter part of my husband's career he managed day and residential units. In this area of London they were, on the whole, of excellent quality. One residential unit that I recall with particular fondness had a wonderful homely atmosphere, home cooked food, regular activities - and dances which the residents particularly enjoyed. Unfortunately, this lovely place has now been closed by the council, presumably to save money, and the provision out-sourced.