The Madison model of community care for the mentally ill: Some lessons for Britain

Abstract

In the light of the government's plan to overhaul the system of community care for the mentally ill and to introduce a new policy committed to protecting the public as well as to supporting the mentally ill, now is an appropriate time to throw light on some of the government's individual proposals. At the heart of the new policy will be a focus on secure accommodation, 24-hour nursing care, outreach teams, crisis intervention capabilities and more acute mental health beds. In addition, greater work opportunities for the mentally ill are to be explored and there is to be a thorough reexamination of the Mental Health Act. However, there are also elements of compulsion at the heart of the government's strategy, as community care orders and provisions for compulsory restrictions on those with severe personality disorders testify. Compulsory community treatment runs the great risk that it will prove to be counterproductive and turn people away from seeking help. In Madison, Wisconsin, there has operated for a number of years a highly successful and comprehensive system of community care, which is predominantly a voluntary service. It is an integrated network of services dedicated both to supporting the mentally ill in the community and to finding them work, whenever possible. There is a professional and system-wide recognition that, with proper support, all but a few mentally ill people can remain living in the community with dignity and with a decent level of independence. Such a recognition runs counter to the apparently growing perception in the UK that the way to handle the seriously and persistently mentally ill is to ‘coerce’ them to take their drugs, or to find new ‘mini-asylums’ where they can be incarcerated. The Madison model provides us with some alternative arguments to those associated with the government's plans for change.