雅思阅读第073套P3-Care in the Community

Care in the Community

‘Bedlam’ is a word that has become synonymous in the English language with chaos and disorder. The term itself derives from the shortened name for a former 16th century London institution for the mentally ill, known as St. Mary of Bethlehem. This institution was so notorious that its name was to become a byword for mayhem. Patient ‘treatment’ amounted to little more than legitimised abuse. Inmates were beaten and forced to live in unsanitary conditions, whilst others were placed on display to a curious public as a side-show. There is little indication to suggest that other institutions founded at around the same time in other European countries were much better.

Even up until the mid-twentieth century, institutions for the mentally ill were regarded as being more places of isolation and punishment than healing and solace. In popular literature of the Victorian era that reflected true-life events, individuals were frequently sent to the ‘madhouse’ as a legal means of permanently disposing of an unwanted heir or spouse. Later, in the mid-twentieth century, institutes for the mentally ill regularly carried out invasive brain surgery known as a ‘lobotomy’ on violent patients without their consent. The aim was to ‘calm’ the patient but ended up producing a patient that was little more than a zombie. Such a procedure is well documented to devastating effect in the film ‘One Flew Over the Cuckoo’s Nest’. Little wonder then that the appalling catalogue of treatment of the mentally ill led to a call for change from social activists and psychologists alike.

Improvements began to be seen in institutions from the mid-50s onwards, along with the introduction of care in the community for less severely ill patients. Community care was seen as a more humane and purposeful approach to dealing with the mentally ill. Whereas institutionalised patients lived out their existence in confinement, forced to obey institutional regulations, patients in the community were free to live a relatively independent life. The patient was never left purely to their own devices as a variety of services could theoretically be accessed by the individual. In its early stages, however, community care consisted primarily of help from the patient’s extended family network. In more recent years, such care has extended to the provision of specialist community mental health teams (CMHTs) in the UK. Such teams cover a wide range of services from rehabilitation to home treatment and assessment. In addition, psychiatric nurses are on hand to administer prescription medication and give injections. The patient is therefore provided with the necessary help that they need to survive in the everyday world whilst maintaining a degree of autonomy.

Often, though, when a policy is put into practice, its failings become apparent. This is true for the policy of care in the community. Whilst back-up services may exist, an individual may not call upon them when needed, due to reluctance or inability to assess their own condition. As a result, such an individual may be alone during a critical phase of their illness, which could lead them to self-harm or even become a threat to other members of their community. Whilst this might be an extreme-case scenario, there is also the issue of social alienation that needs to be considered. Integration into the community may not be sufficient to allow the individual to find work, leading to poverty and isolation. Social exclusion could then cause a relapse as the individual is left to battle mental health problems alone. The solution, therefore, is to ensure that the patient is always in touch with professional helpers and not left alone to fend for themselves. It should always be remembered that whilst you can take the patient out of the institution, you can’t take the institution out of the patient.

When questioned about care in the community, there seems to be a division of opinion amongst members of the public and within the mental healthcare profession itself. Dr. Mayalla, practising clinical psychologist, is inclined to believe that whilst certain patients may benefit from care in the community, the scheme isn’t for everyone. ‘Those suffering moderate cases of mental illness stand to gain more from care in the community than those with more pronounced mental illness. I don’t think it’s a one-size-fits-all policy. But I also think that there is a far better infrastructure of helpers and social workers in place now than previously and the scheme stands a greater chance of success than in the past.’

Anita Brown, mother of three, takes a different view. ‘As a mother, I’m very protective towards my children. As a result, I would not put my support behind any scheme that I felt might put my children in danger… I guess there must be assessment methods in place to ensure that dangerous individuals are not let loose amongst the public but I’m not for it at all. I like to feel secure where I live, but more to the point, that my children are not under any threat.’

Bob Ratchett, a former mental health nurse, takes a more positive view on community care projects. ‘Having worked in the field myself, I’ve seen how a patient can benefit from living an independent life, away from an institution. Obviously, only individuals well on their way to recovery would be suitable for consideration as participants in such a scheme. If you think about it, is it really fair to condemn an individual to a lifetime in an institution when they could be living a fairly fulfilled and independent life outside the institution?’

SECTION 3: QUESTIONS 26-40

Questions 26-31

Choose the correct letter, A, B, C or D.

26Which of the following statements is accurate?

AIn the 20th century, illegal surgical procedures were carried out on the mentally ill.

BThe Victorian era saw an increase in mental illness amongst married couples.

CMental institutions of the past were better-equipped for dealing with the mentally ill.

DIn the past, others often benefitted when a patient was sent to a mental asylum.

27What does the writer mean by patient treatment being ‘legitimised abuse’?

AThere were proper guidelines for the punishment of mentally ill patients.

BMaltreatment of mentally ill patients was not illegal and so was tolerated.

COnly those who were legally entitled to do so could punish mentally ill patients.

DPhysical abuse of mentally ill patients was a legal requirement of mental institutions.

28What brought about changes in the treatment of mentally ill patients?

AA radio documentary exposed patient maltreatment.

BPeople rebelled against the consistent abuse of mentally ill patients.

CPrevious treatments of mentally ill patients were proved to be ineffective.

DThe maltreatment of mentally ill patients could never be revealed.

29What was a feature of early care in the community schemes?

APatient support was the responsibility more of relatives than professionals.

BAdvanced professional help was available to patients.

CAll mentally ill patients could benefit from the scheme.

DPatients were allowed to enjoy full independence.

30What is true of care in the community schemes today?

AThey permit greater patient autonomy.

BMore professional services are available to patients.

CFamily support networks have become unnecessary.

DAll patients can now become part of these schemes.

31What can be said of the writer’s attitude towards care in the community?

AHe believes that the scheme has proved to be a failure.

BHe believes that it can only work under certain circumstances.

CHe believes that it will never work as mentally ill patients will always be disadvantaged.

DHe believes it has failed due to patient neglect by professional helpers.

Questions 32-36

Look at the following statements, 32-36, and the list of people, A-C.

Match each statement to the correct person.

32 __________This person acknowledges certain inadequacies in the concept of care in the community, but recognises that attempts have been made to improve on existing schemes.

33 __________ This person whilst emphasising the benefits to the patient from care in the community schemes is critical of traditional care methods.

34 __________ This person’s views have been moderated by their professional contact with the mentally ill.

35 __________ This person places the welfare of others above that of the mentally ill.

36 __________ This person acknowledges that a mistrust of care in the community schemes may be unfounded.

Questions 37-40

Do the following statements agree with the information given in the text?

For questions 37-40, write

37 _________________ There is a better understanding of the dynamics of mental illness today.

38 _________________ Community care schemes do not provide adequate psychological support for patients.

39 _________________ Dr. Mayalla believes that the scheme is less successful than in the past.

40 _________________ The goal of community care schemes is to make patients less dependent on the system.