Care in the community

Kimo was like a Hollywood version of a Vietnam Vet, except he was real. During lunchbreaks, he'd sit sharpening his hunting knife, talking to no one. While he worked, the knife was in his belt, and a gun was in his boot, a .38 revolver. Under the seat in his truck was a .44 magnum he'd had bored out to take .45 rifle bullets. Behind the front seats, a gun rack held a couple of shotguns and a hunting rifle, and in the back was a case of dynamite. When the salmon factory ran out of money and nobody knew who was going to be paid, Kimo put the dynamite somewhere in the plant and told the foreman that he'd be one of the lucky ones. But that was later.

Kimo wasn't very sociable, but most of the workers there were students from the "lower 48", earning cash during the summer break of 1981 - people like Danny, a heavy-set party animal from Syracuse who specialised in Three Stooges impersonations and planned to be a doctor because that was where the money was. He drove an old camper van and one evening we were all stopped by State Troopers because he was driving too slowly - practically at walking pace. Colombian grass and Wild Turkey had made him the safest driver in Alaska that evening, but he still spent the night in the drunk tank.

The salmon factory was a couple of miles outside the town of Kenai, south of Anchorage. Nearby, a tent city had sprung up, as it did every summer, in the shadow of the woods. On warm evenings we'd light bonfires and watch the sun go down behind the mountains across the Cook Inlet. Guitars would be played, joints lit, cases of beer unloaded from a car sent into town for these vital supplies. If people had planned ahead, they'd bake potatoes in the embers of the fires, and roast hot dogs in the flames. Most hadn't.

But Nelson always had. He'd roast his hot dogs, and unwrap the foil from his potatoes with a smile, watching out of the corner of his eye to see who'd noticed. Tall, heavily built and immensely strong, somewhere in his mid-twenties, Nelson worked loading cases of king crabs onto trucks on Kodiak Island in the winters, and loading cases of frozen salmon onto trucks in Kenai in the summers. It's hard to estimate these things meaningfully, but I'd guess his mental age was somewhere around ten.

When I first started work there, he heard me speak and knew my accent was strange. During lunch, he asked where I was from. I said London, England - which was close enough. I thought he'd have heard of it. He had, sort of. How long would it take to drive there, he asked.

There was a sort of watchfulness in the canteen. Nobody stopped talking, but the conversations had shifted down a gear. Kimo's knife sharpening had grown slower, more deliberate. He studied the blade for a moment, then resumed. Nobody knew me and nobody had anything against me, but people were generally protective of Nelson. If I'd started mocking him, or in any way tried to take advantage of his slowness, I'd have found myself facing everyone in the plant, from the foreman, through Kimo, to the preppiest college student. That's how it was.

I've only ever encountered something like this once before. On the Isle of Skye in 1976 I was with some people waiting in a pub for the ferry. It was a wait of a couple of hours, and we were being introduced to Talisker, the local malt. A Down's syndrome teenager was also in the pub, vastly friendly, unaware of his own strength, laughing, curious as a kitten and every much a part of the community as the barman who was trying to blind-test us on the different strengths of the whisky.

We don't have village idiots anymore. That probably has less to do with inbreeding than is commonly thought. There are still lots of mentally disabled people about. Or rather, not about. The point about village idiots was that they were in the village, like Nelson, like the Down's kid on Skye.

Care in the community was:

... a policy of the Margaret Thatcher government in the 1980s. Its aim was a more liberal way of helping people with mental health problems, by removing them from impersonal, often Victorian, institutions, and caring for them in their own homes. Also, better drugs became available and this meant that patients could be treated at home. It was also meant to reduce the cost of institutionalizing so many mentally ill people.

I visited one of those Victorian asylums once, in the early '80s. Shaven-headed people in pyjamas wandered, confused, through endless shabby corridors painted bile-vomit institutional green. It was a nightmarish place.



This image is from the BBC's website entry announcing the end of the care in the Community programme:

The Junior Health Minister, Paul Boateng, is supervising the review of mental health care.

"There will be no return to the grim Victorian asylums. But the old mantra, `community good, hospital bad' is dead," he said.

There had been several high profile murders committed by mental patients. But Nelson wasn't schizophrenic. He wasn't a danger to anyone. I don't see any Nelsons in the towns of England.

There is a Mencap estate near Cambridge where Down's syndrome people live a supervised life in neat new houses. But a ghetto isn't the community. Right now, I'm not sure what is. Migrant workers in a tent city do form a strong community. So do settled and stable populations like Skye in the 1970s. But we're falling between those two stools in English society today. The word "community" is used almost fetishistically, but it has come to mean its opposite - a faction, a ghetto, a splintering of the community which actually needs to comprise us all if it is to be meaningful.

Calling people carers doesn't mean they care. The bird-light nonagenarian mother of one of my friends was left sitting, day after day, in her own waste at home because people with the job title "carer" didn't want to risk hurting their backs if they lifted her.

Nelson didn't need any care at all, in the sense of state intervention; he was completely independent. But he did need to be in a community where people cared. In this country, we don't. Disabled people, especially the mentally diabled, make us feel uncomfortable. They're "raspberries" (raspberry ripple = cripple). And when you really don't give a damn, you get the state to take them away and you dress it all up in deceitful, sanctimonious language.

The flaw with the Care in the Community programme, above all else, was that we don't have a community, and we don't care.