The origins of community care

Community care led to mass hospital closures

Care in the community represented the biggest political change in mental healthcare in the history of the NHS.

It was the result both of social changes and political expediency and a movement away from the isolation of the mentally ill in old Victorian asylums towards their integration into the community.

The aim was to "normalise" the mentally ill and to remove the stigma of a condition that is said to afflict one in four of the British population at some time in their lives.

The main push towards community care as we know it today came in the 1950s and 1960s, an era which saw a sea change in attitude towards the treatment of the mentally ill and a rise in the patients' rights movement, tied to civil rights campaigns.

The 1959 Mental Health Act abolished the distinction between psychiatric and other hospitals and encouraged the development of community care.

The 1960s

Through the 1960s, the tide continued to move against the big hospital institutions.

Psychiatrists questioned traditional treatments for mental illness.

R.D. Laing, for example, suggested that social rather than medical reasons were responsible for schizophrenia.

He also opposed the standard treatments for the illness, including electro-convulsive therapy and hospitalisation.

The introduction of a new wave of psychotropic drugs in the 1960s also meant patients could be more easily treated outside of an institution.

Another significant development was the growth of patients' and civil rights movements and the increase in charities which championed them.

The old mental asylums have gradually been closed down

Coupled with this were changes in social attitudes.

In the first part of the century, for example, asylums were used to house a wide variety of people, including single women who had fallen pregnant.

Many remained there throughout their lives.

In addition, right-wing civil libertarians like former health minister Enoch Powell, dubbed by some the Father of Community Care, argued that mental hospitals were effectively prisons, preventing a return to normal life.

There was also a belief that community care would be cheaper than hospital care, although in recent years mental health campaigners have consistently argued that, if properly funded, it is more expensive.

During the 1970s, large-scale psychiatric hospitals were steadily discredited.

The new district general hospitals which provided some psychiatric services contributed to the reduction in the number of beds in mental hospitals from 150,000 in the mid-1950s to 80,000 by 1975.

The 1980s

The 1980s saw the introduction of legislation which would give the mentally ill more rights.

The Mental Health Act 1983, currently under review, set out the rights of people admitted to mental hospitals, allowing them to appeal against committal.

A recent case in the House of Lords sought to extend those rights to vulnerable people who have been informally admitted to hospital, bypassing the Act.

It failed due to fears that a change would increase the number of people being committed to hospital, reflecting the shift in attitude away from hospitalisation.

However, by the 1980s concerns were being expressed about care in the community following a series of killings by people with mental health problems.

The 1984 murder of social worker Isabel Schwarz by a former client prompted a government inquiry into community care, led by Sir Roy Griffiths.

His 1988 report, 'Community Care: Agenda for Action' was the forerunner to the Community Care Act of 1990, major legislation which sets out the basis for community care as we know it today.