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Progress or neglect? Reviewing the impact of care in the community for the severely mentally ill

East Cheshire NHS Trust

For over one hundred years the large Victorian mental hospitals domi nated the provision of services for people with a serious mental illness. Many of these hospitals have now closed and the future for those remaining is uncertain. Mental Health services are now provided pre dominantly in the community and this new pattern of services has been subject to considerable debate and controversy following public and pol itical concern that this approach is failing. The purpose of this article is to consider the impact of care in the community for the severely ill. To do this it will be necessary to review the origins and content of this approach to care and to briefly remind the reader of the main critique of the large institutions, for so long the focus of care. The article will then consider the impact of community care on both the patients who left the large mental hospitals and the new generation of individuals who have developed mental health problems since the hospital closures.

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