It may be ‘Community’ but is it Comprehensive: A Wrong Question?

Extract

The debate on the place of community psychiatry is conducted as if it were a matter of choosing between service in the community on one hand and hospitals on the other. When expressed as a dichotomy the question, as illustrated by Scull's Dilemma (Jones, 1982), may be unanswerable. Instead, should we not ask what range of co-ordinated services are required to provide a comprehensive service for the mentally disturbed in a geographically-defined community? The key word then becomes comprehensive with community, in the sense of extra-hospital, important but subordinate. The hospital is then seen as part of the service; it is of the community, not alien to it. Other service components need not be anti-hospital, but hospital staff will need to avoid institutionalism and live down prejudice. The debate about what we can afford, although relevant, is separate.