Community mental health in the UK: restructuring for the 21st century

Mental health service delivery in the UK has been subject to renewed policy scrutiny over the past decade. Mirroring moves in other countries, the focus of care has shifted from large institutions to community based services. There have been many benefits and some problems with this shift, not least in regard to public perceptions of the dangerousness of individuals with mental health problems. Concerns about discrimination and the social exclusion of the mentally ill are receiving attention by both central government and the devolved assemblies. The rise of the service user advocacy movement is evidenced by the increasing attention given to service user views in policy, research, education, service development and evaluation. Despite the clear rhetoric of involvement these changes have occurred in the face of calls and subsequent government moves to increase levels of compulsion and treatment of the mentally ill who are deemed dangerous. Mental health service development in the UK is aiming to restructure and ‘modernise’ for the 21st Century, and proclaims itself to be doing so with recourse to the development of evidence-based interventions. However we also acknowledge a 19th Century zeal with which larger and larger forensic units are being built in what might be regarded as the effective reinstitutionalisation of the mentally ill