Social networks in ‘community care’

Sir: Leff et al's finding (Psychiatric Bulletin, May 2000, 24, 165-168) that the majority of the ‘TAPS’ cohort lead impoverished social lives contrasts with the original vision of community care. Their reference to the nature of severe psychiatric illness seems to imply that this is responsible. Many seriously ill former long-stay patients have shown unexpected potential for social and personal relationships in coping with a relocation that would have taxed any demographically similar population, irrespective of mental illness. Most also faced a policy of confining them to small, dispersed groups (Heginbotham, 1985) on the assumption that this would automatically spawn social networks in ‘the community’ and with an unpleasant implication that relationships among themselves were second best that has not been entirely avoided by TAPS.

Such impoverishment should not be accepted for de-institutionalised patients, even at this late stage, and services for other groups, including assertive outreach and home care, also need fully to incorporate social network considerations if they are not to lead to similar disappointments. The TAPS review will hopefully stimulate debate; and I would suggest an approach based on the promotion of a network of varied relationships across a range of activities and settings (Abrahamson, 1997).