Forty years ago Houston wrote: “By incarceration we were aggravating the natural process of the disease. At last a new era is dawning and the doors of despair are being unlocked.”1 Since 1954 the number of psychiatric beds in Britain has fallen by almost two thirds to 50 278.2 The key issue about this trend is, how far is far enough? Do we now need more or fewer psychiatric beds? To debate this thoroughly the emphasis should be on the whole mental health service system rather than on numbers of beds alone. Four issues need to be directly addressed: the mental health services required in each local area, the needs for secure provision and the links between forensic and community services, integrated methods of efficient management of psychiatric beds, and interagency working arrangements.

Not only beds are needed. As the Health of the Nation's key area handbook on mental illness indicates, a consensus now exists about the range and scale of services required in each local area.*RF 3-5* The inquiry by the House of Commons Health Select Committee into services for seriously mentally …