Complexity and Change in the United Kingdom's System of Mental Health Care

In the context of wider efforts to improve efficiency and the user-centeredness of health and social care provision, public policy in the United Kingdom (UK) demonstrates an explicit appeal to ‘whole systems’ management. This otherwise laudable attempt to develop services may, however, reveal an underestimation by policymakers of how complex systems of work can evolve in unpredictable ways. In this paper we utilize sociological theories of the division of labour to underpin a wide-ranging case study of the historical evolution and current characteristics of the ecology of mental health care in the UK. Beginning with an analysis of the development of a system in which psychiatry emerged as the lead profession, and progressing to a review of the challenges faced by psychiatric knowledge and practice, we highlight the interrelated and dynamic features of this system of work. Our paper closes with an examination of contemporary ‘modernization’, which we argue has the potential for triggering widespread system disturbance