BACKGROUND: The 50th anniversary of the inauguration of the NHS provided the occasion to review the evolution of mental health services and of psychiatry itself in Britain during that period. AIMS: The principal themes to be followed were the decline of a mental hospital system that had existed for over a century, the development of an alternative policy of 'community care', the emergence of a numerous and well-trained psychiatric profession, and the interaction between political and legal processes and mental health care. METHOD: An examination of Ministry of Health and Department of Health and Social Security files in the Public Record Office, interviews with influential figures, examination of the secondary literature, and personal experience of events described. RESULTS: The material has been analysed, in the light of the expressed aims, and important trends have been described. The current situation is assessed. CONCLUSIONS: The replacement of one system of care and treatment in Britain by another has been a process fraught with overwhelming difficulties. While adhering to the aim of 'community care', governments have been reluctant to provide the means for achieving this. The psychiatric profession is now faced with very large but ill-defined responsibilities.
BACKGROUND: The 50th anniversary of the inauguration of the NHS provided the occasion to review the evolution of mental health services and of psychiatry itself in Britain during that period. AIMS: The principal themes to be followed were the decline of a mental hospital system that had existed for over a century, the development of an alternative policy of 'community care', the emergence of a numerous and well-trained psychiatric profession, and the interaction between political and legal processes and mental health care. METHOD: An examination of Ministry of Health and Department of Health and Social Security files in the Public Record Office, interviews with influential figures, examination of the secondary literature, and personal experience of events described. RESULTS: The material has been analysed, in the light of the expressed aims, and important trends have been described. The current situation is assessed. CONCLUSIONS: The replacement of one system of care and treatment in Britain by another has been a process fraught with overwhelming difficulties. While adhering to the aim of 'community care', governments have been reluctant to provide the means for achieving this. The psychiatric profession is now faced with very large but ill-defined responsibilities.