Psychiatrists, stigma and unlimited responsibility

Sir: Howlett (Psychiatric Bulletin, August 2000, 24, 287-288) has an incontestable right to advance the concerns of those affected by homicides perpetrated by psychiatric patients, particularly if they are deemed to have occurred as a consequence of failed community care. Nevertheless he appears unable to give nuanced and contextually relevant arguments as evidenced by his most recent commentary (Psychiatric Bulletin, November 2001, 25, 414-415). This, to my mind, illustrates the invidious position we straddle between the Government/pressure group instigated paternalism and the respect for autonomy so beloved of our patients. He appears to marshal point after point in pursuit of his central thesis that we as a group have not been called to account as frequently and severely as our perceived failings would suggest we deserve. And in the process convicts himself of an overarching stigmatising prejudice towards patients who kill and ourselves as their responsible medical officers. Casting them as if grotesques — medication- and supervision-free, roaming the streets looking for victims — and ourselves as overpaid incompetents. Surely the real issue is the rather low priority given to our patients by successive governments in the face of unemployment, poor housing, derisory benefit entitlement, badly resourced services and demoralised staff. All of the aforementioned occurring in a deeply fearful and prejudiced society, where the press continues to poison the atmosphere with sensational and jaundiced reportage. The gloves should come off and psychiatry needs to shout a lot louder, ‘more resources and less of the stigma’. Something I am happy to say has started in earnest!