Road to the lake

The day started with going for a blood test. They open early. Then a meeting of those of us not on leave (as a locum, I don't get leave!). After which there was a presentation by one of the senior trainees. She is working in the forensic services. In her introduction to the case history she was discussing she referred rather briefly to the deinstitutionalisation which began in the 1950s. She gave the accepted version. That patients were made well enough to be discharged by the discovery of the antipsychotic drugs in the 1950s.
Discussion was slow to start so I offered an alternative view. First put forward by an English psychiatrist working in Boulder, Colorado. Richard Warner. After showing that from the mid 19th century until the 1970s the occupancy of psychiatric hospitals varied with the unemployment rate. The higher the unemployment rate, and therefore the harder for the mentally ill to get jobs, the higher the occupancy of the old institutions.
Following the Second World War and the huge loss of young men to provide labour, even the mentally ill were employable and occupancy rates fell from 1948 onwards. The antipsychotic medications contributed to further discharges from the mid 1950s on.
The monetarist policies pursued by all western governments in the last 30-40 years has changed that simple relationship. As a matter of economic management unemployment is kept above 5%, meaning that severely mentally ill persons have little chance of employment. But the monetarists have closed the big institutions without providing any reasonable alternative. Consequently, the severely ill, are often homeless, in prison, or in forensic hospitals. The last can almost be seen to have replaced the bad old bins as they came to be called.
I am not advocating for large institutions; merely wanting a humane approach to meeting the needs of persons who are often alienated and have few skills.
Afterwards, I walked back to the unit and on the way took another photo of the road to Pupuke Moana.
Now up at the beach house for the first time in a month. No internet connection in the house, so using my iPad via the mobile telephone system.