When half-truths do more damage than outright lies

It is sometimes suggested that "A truth that's told with bad intent beats all the lies you can invent."

Similarly half-truths can do far more damage than outright falsehoods. In an article by Patrick Cockburn in the Independent this week called  Weasel Words that politicians use to obscure terrible truths he expressed one opinion which was commonly held a couple of decades ago, was sometimes right and more often wrong, but which did far more harm to some of the most vulnerable members of society than the worst outright lie could have done.

Patrick Cockburn was writing about government euphemisms and misleading phrases, among which he counts the name of a policy supported by both Labour and Conservative governments in an attempt to provide more humane care for those with a mental illness or mental handicap.

Three or four centuries ago, those who we would now recognise as mentally ill or unstable were in grave danger of being labelled as blasphemers or witches and put to death by the public executioner, often in cruel and barbaric ways.

About two hundred years ago, the existence of mental illness began to be better understood, and society adopted a better, but still far from ideal approach: those who were certified as insane were locked away in what were at first called lunatic asylums, and then mental hospitals, which amounted to a second prison system with various degrees of more or less appropriate medical care available. This was far more humane and appropriate than what had gone before, but it still meant that people who were labelled mentally ill could find themselves locked away for life for comparatively minor offences when they were embarrassing rather than dangerous or seriously evil.

Even more than death, mental illness was the last taboo, and those who were thought to suffer it were locked away from society in huge instititions in the countryside where they were out of sight and out of mind.

In the second half of the twentieth century Britain attempted to reform that policy further. The new policy was known as "Care in the Community" and this expression is one of the terms Patrick Cockburn took exception to in his article.

The opinion he expressed, a very common view some twenty years ago which did massive damage when it was wrong but very little good when it was true, was that

"care in the community meant people being kicked out of hospitals," or in more detail,

"When 'Care in the Community' was introduced in Britain it meant that people living in mental hospitals which were being sold by the government were kicked out to be looked after by a community which either feared or ignored them."

That is a travesty of what the policy was meant to be about.

At the time I was first appointed as a Health Authority member in 1988 there were elderly people in mental hospitals who had been put there many decades before for such offenses as giving birth to an illegitimate child or petty theft. Some of these people were by now hopelessly institutionalised but there were others in mental hospitals who were not dangerous to themseles or others, and for whom lifetime incarceration was neither necessary nor proportionate to any offences they had committed.

A small proportion of those who are mentally ill or have learning difficulties are dangerous to themselves or others and do need to be detained in a secure unit. The vast majority people who suffer from such conditions are not dangerous - far less so than someone who is sane but evil - and do not need to be locked away.

When "Care in the community" was applied properly it meant replacing most of our old mental hospital with better, more humane, and less prison-like facilites on a more human scale.

The grain of truth in the opinion voiced by Patrick Cockburn in his article is that when the policy was applied badly - which did occasionally happen - it could mean escorting people out of the front gate and forgetting about them.

But the tragic irony is that applying the policy properly and building new, more appropriate care facilities for mental patients was not just more expensive and difficult to implement than simply discharging those patients.

The planning system, property law, and requirements on the NHS to consult the public about changes to services gave protestors many opportunities to object to, delay, and often successfully frustrate attempts to new provide new facilities, while there were no equally effective mechanisms to prevent the NHS from simply discharging a patient.

So it was far easier for opponents of the policy to stop it from being applied properly than it was for them to stop patients being, in Cockburn's words, kicked out of hospital.

The fact that some people who claimed to have the interests of patients at heart expressed the view that "Care in the community" was bad for patients gave those who didn't want a new care facility built in their neighbourhood an excuse to object to the planning application for the new facility, try to enforce land covenants against the proposal, even in some cases club together to outbid the NHS for properties which might otherwise have been bought as places to care for these patients. As a health authority member and then local council planning chairman in the late eighties and early nineties I saw all these things happen.

The belief that "Care in the Community means kicking people out of hospital" was part of the problem, not part of the solution, because it encouraged objections to the provision of new facilities which were intended to give those detained in mental hospitals a better life.

At best this delayed the provision of those facilities and increased their cost. At worst in a few cases this may even have been a self-fulfilling prophecy which created exactly the problem which the critics feared.

It is often said that "A little knowledge is a dangerous thing." Sometimes well meaning and incompletely informed people can do far more damage than those who are completely ignorant or downright evil.


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