What kind of society do we want?

A few days ago the mother of a mentally retarded young man was at the end of her tether, unable to cope any longer with a big, strong man with a mental age of about 2 years. She dropped him and a suitcase of his belongings at the offices of Community and Social Services.  Since then over 700 other distraught parents in a similar plight have come forward, clamouring for help. It's the inevitable sequel to the closure a few years ago of a regional residential centre for the care of mentally retarded adults, just as the presence of large numbers of homeless mentally ill 'street people' is the inevitable sequel to closure and demolition of mental hospitals. On the radio politicians pontificate about this lamentable state of affairs, call-in radio shows are swamped with distress calls, but nobody does anything. It's glaringly obvious that closure and demolition of large custodial institutions for the mentally retarded and the mentally ill several decades ago was a catastrophic error - a cop-out really - by psychiatric "experts" who claimed to believe that what they were doing was progressive, enlightened, in the best interests of people with damaged brains or minds. I recall conversations in the 1970s in which I and a few other epidemiologists predicted that this would happen.  It wasn't enough to say that community mental health services would care for these pathetic individuals and their families. There are no community mental health services, or rather there are grossly inadequate mental health services. Custodial mental health care would surely be preferable to prisons and the street.  But it would be an admission of defeat and error and a very costly business to re-establish institutional care.  In the 1960s at the University of Edinburgh I worked with Maxwell Jones, an enlightened forward-looking psychiatrist who had set up a "therapeutic community" centred around  Dingleton Hospital, a 900-bed custodial mental health institution in the Scottish Borders about 60 Km south of Edinburgh. Patients lived in the hospital as before but were not confined within it, and the services they needed were relocated in the village of Dingleton, which benefited the ailing local economy.  Mental health services in Canada have been a lamentable failure because of failure to adopt the therapeutic community model. It's been said that a society can be judged by the quality of care it provides for those unable to care for themselves. By this criterion, Canada is in a shameful condition.