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Niall McCrae: Safer care of psychotics not political point-scoring should be Jo Cox’s legacy


As a lecturer and practitioner in mental health, with nearly thirty years of experience, I am saddened but not completely surprised that another deranged, psychopathic person has taken the life of a public servant. Dealing with the chaotic mix of people who make up society has hazards, particularly for those in positions of power or acting on the State’s behalf: this includes police officers, social workers, doctors and nurses. Members of Parliament are certainly vulnerable; they ordinarily receive abuse from angry constituents, and open surgery may no longer be possible in the light of the awful killing of Jo Cox, and the attempted murder with a knife in 2010 of East Ham MP Stephen Timms.

Hours before the tragic homicide, Thomas Mair, the accused, had sought help for his mental distress but no action was taken. This is similar to a recent case in Bexleyheath, when a young woman with a past history of matricide had gone to a hospital emergency department to stop her from acting out her psychotic rage. While awaiting admission, she left a a psychiatric unit, walked to the nearby high street and savagely attacked two random women with a knife taken from a butcher’s shop, one of whom died.  There is no straightforward way of detecting an imminent act of extreme aggression in these situations, but we cannot continue with the current approach.

In mental health, there is so much emphasis on tackling stigma, and in refuting the inaccurate association of mental disorder with violence, that we tend to overlook the fact that people with severe psychotic symptoms have a much greater risk. That is why we have the Mental Health Act: sometimes patients need care in a safe, locked ward as the only way of preventing harm to themselves or others.

As a historian of mental health care, I see longer patterns in the provision of services for people with mental disorder. I am very aware of the shortcomings of the old institutional system, and the neglect and abuse that occurred within the walls of the former asylums. We should not look back with rose-tinted glasses.

However, the number of psychiatric beds for acutely ill patients has fallen to a dangerous level. Patients who really should be in hospital are visited by home treatment teams. A practitioner visits three or four times daily, but with so many on the caseload, this input is little more than checking that medication is taken, and that the patient or family is not at immediate risk of harm. Meanwhile, acute wards are so pressurised that patients are discharged before they are fully stabilised. I coined the term ‘peak community care’ for this current phase, warning that tragedies would occur and result in a return to institutional facilities. Incarceration is not a happy consequence of the complacency that has emerged among policymakers and practitioners, who tend to listen too much to libertarian service-user activists.

Pursuing a safer system of care should be the focus in the aftermath of the killing of Jo Cox. There is no excuse in using it for broader political ends. Yet the pro-EU establishment and liberal-left media have already gone beyond the pale in using it to swing the referendum their way, directly relating a psychotic assassin to the increasingly successful Leave campaign. After a respectful period of silence, canvassing should now resume. This plebiscite is a once-in-a-lifetime opportunity to retrieve our democracy and autonomy. Let people power trump cynical manipulation.

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