Independent living

A century ago, if you were mentally ill, handicapped or otherwise infirm, the plan was that you went to live in an asylum. Unless, that is, you were wealthy, came from a wealthy family, were in a prison or in a workhouse.

Asylums were large places, some with a thousand or more patients, in some ways not that unlike the prisons of their day, with which they sometimes shared architects. They often had extensive, handsomely laid out grounds, farms, workshops, laundries and kitchens. Maybe a church, a theatre and a ballroom. Some of them attained an admirable degree of self sufficiency. Made their own cheese. There was plenty of work, plenty to do for those sufficiently able.

Some of these asylums were run on quasi-religious lines and some tried hard to break down the barriers between staff and patients, to be more of a community. The name of Rudolf Steiner comes to mind.

But they were institutions and life was institutional. Many patients were institutionalised. Many patients lived in dormitories and there was little privacy - which last being something that some of them hated.

So over the past half century or so there has been a move towards independent living. In one case that we know of a small block of one bedroom flats has been built to take some of the patients from the community in which they had been living. For some of these patients, independent living is only viable on the basis of their getting perhaps 30 hours one-on-one support a week. Support which will, inter alia, get the shopping, the cooking and the laundry done. My impression is that the patients are very happy with this arrangement. They did not want community and did want some semblance of normal life with their own front door and their own set of keys, even if they did have trouble working the telephone and the refrigerator.

When I first came to hear of this, it all struck me as terribly extravagant. One would only be able to do this for a very small number of patients, at the expense of the larger number. The larger number who were probably still in the much smaller asylums, mostly privately run, some rather shabby, which we now favour, the large old asylums having nearly all been closed down, knocked down and their land given over to housing estates.

But I am told independence is not as expensive as one might at first think. The unit costs of the smaller asylums are not that different. So let's hope that the people who worry about these things have got it more or less right - or at least as right as they can be given the rather limited resources we allow them.

PS: the Nuffield Trust web site suggests that maybe 1 in a 100 people have a severe mental problem at any one time. So leaving aside the considerable statistical problems with numbers of this sort, maybe a million people in the UK altogether, a thousand old-style asylums' worth.