Changing services I: Clinical psychiatric perspectives on community and primary care psychiatry and mental health services (Turner, 2021)

Turner Trevor. Mind, state and society: Social history of psychiatry and mental health in Britain 1960–2010 2021; 222.

From the point of view of a practising consultant psychiatrist working in the system, this chapter focuses on an impressionistic understanding of how community care has developed and not developed and the extent to which it can be seen as a success or failure. The process of de-asylumisation into a community care–based mental health system has been a messy business, a social crusade rather than a clinically thought-out process. Concomitants like modern psychopharmacology and the effects of the Royal College of Psychiatrists' anti-stigma campaigns have helped, but care has varied substantially in quality across the country. Community care has relied on the qualities of individual psychiatrists and Community Mental Health Team members, as well as local general practitioners and/or social services support, generally not helped by the numerous government White Papers. The reversion to medium-secure mental health units and reinstitutionalisation has been a core feature, publicly unrecognised. Mental health services have coped to varying degrees despite their core asylum resource being stolen from them, and the key need now is for the elimination of the primacy of risk assessment and the maintenance of the generality of general adult psychiatry. (PsycInfo Database Record (c) 2025 APA, all rights reserved)