Improving mental health services in England

Documents on mental health policy tend to be diffuse and careful. They are aspirational rather than rational, tiptoe around the snags of stigma and different interest groups, and they do not commit funds.

Once it was simple. There were some 120 asylums (mental hospitals), and local authorities and ratepayers paid for them. Since the closure of these hospitals in the 1970s and 1980s we have had community care (dubbed “other people, somewhere else” by a leading academic). It was a policy that was stumbled into as humane and embraced “normalisation,” a watch word akin to the “recovery model” that adorns all modern documentation. Struggling under the steady cannonade of homicide inquiries (20-30 a year since the mid-1990s), initiated by the Clunis report of 1994,1 mental health services have had to endure the care programme approach, risk management (a phrase unseen in psychiatric textbooks until the mid-noughties), and fragmentation.

Thus the NHS plan of 2002 introduced packaged new teams, such as “crisis intervention” and “assertive outreach,” apparent additions to the standard (and rather effective) community mental health teams that served each locality. With the …