Proper systems are needed to develop, manage, and monitor cooperation between public and private sectors

The British government is promoting close cooperation between the NHS and the private sector.1 In mental health care, an outcry over conditions in private “madhouses” led to legislation and the establishment of county asylums in the early 19th century, almost eliminating private care.2 The number of beds for people with mental illness in the NHS dropped from a peak of 148 000 in 1954 to 35 740 in 2000. 3 4 As this decline accelerated, a thriving private market in the provision of beds for long stay patients emerged.5 It is time to consider the consequences.

One of the successes of community care has been the ability of non-statutory organisations to provide a diversity of supported housing. The private provision of long term inpatient care is more problematic. The lack of NHS facilities for patients whose behaviours are intractably difficult to manage or who have unusual psychiatric needs has been exploited as a market opportunity by largeand small businesses. For example, over a …