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Chapter 8 - Mental Health Services and Policy in the United Kingdom

from Section 1 - Social Exclusion, Poverty, and Inequality

Published online by Cambridge University Press:  24 November 2022

Jed Boardman ,
Helen Killaspy  and
Gillian Mezey
Jed Boardman
Affiliation:
King's College London
Helen Killaspy
Affiliation:
University College London
Gillian Mezey
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Here we examine governmental policies that affect how people with mental health conditions are treated in society. The development of UK mental health services has been closely associated with the evolution of social policies, the increasing role of the state in the provisions for the population’s well-being, and the ‘Welfare State’. The provision of poor relief, dating from the Elizabethan Poor Law to its Victorian revision, has dominated the care of people with mental health conditions, both within and outside of institutions. Until the nineteenth century, the British state played a minimal role in the care of mental ill-health, and the 1800s witnessed a substantial growth in publicly funded asylums. These County Asylums were Poor Law institutions and remained so into the twentieth century. The UK’s modern mental health services arose from the Beveridge welfare state reforms but carried with them much of the baggage of the Victorian Poor Laws. The close relationship between the welfare state and mental health services illustrates the importance of social policy provision relating to income, employment, housing, education, health, and personal social services, to the broader provision of services for people with mental health conditions and the running of effective mental health services.

Keywords

Welfare StatePoor LawsCounty AsylumsCommunity CareMental Health PolicyMental Health Act
Type
Chapter
Information
Social Inclusion and Mental Health
Understanding Poverty, Inequality and Social Exclusion
 , pp. 161 - 186
Publisher: Cambridge University Press
Print publication year: 2022

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References

Ashton, J. R. (1979) Poverty and health in Britain today. Publ Heal Lond 93, 89–94.Google Scholar
Audit Commission (1986) Making a Reality of Community Care. HMSO.Google Scholar
Audit Commission (1992) Community Care: Managing the Cascade of Change. HMSO.Google Scholar
Audit Commission (1994) Finding a Place: A Review of Mental Health Services for Adults. HMSO.Google Scholar
Bartlett, P. (1998) The Asylum, the workhouse, and the voice of the insane poor in 19th-century England. International Journal of Law and Psychiatry, Vol. 21,4, 421–32.Google ScholarPubMed
Bartlett, P. (1999) The Poor Law of Lunacy. Leicester University Press.Google Scholar
Bartlett, P. & Wright, D. (1999) Outside the Walls of the Asylum. Athlone Press.Google Scholar
Bateson, G. (1972) Steps to An Ecology of Mind. Ballantine Books.Google Scholar
Boardman, J. & Parsonage, M. (2007) Delivering the Government’s Mental Health Policies: Service Staffing and Costs. Sainsbury Centre for Mental Health.Google Scholar
Dean, H. (2019) Social Policy. 3rd ed. Polity Press.Google Scholar
Department of Health and Social Security (1971) Hospital Services for the Mentally Ill. HSMO.Google Scholar
Department of Health and Social Security (1975) Better Services for the Mentally Ill. (cmnd. 6233) HSMO.Google Scholar
Department of Health and Social Security (1988) Report of the Committee of Inquiry into the Care and After-Care of Miss Sharon Campbell. Cm 440. HMSO.Google Scholar
Department of Health (1999) National Service Framework for Mental Health: Modern Standards and Service Models. Department of Health.Google Scholar
Department of Health (2000) The NHS Plan: A Plan for Investment, A Plan for Reform. Cm 4818-I. The Stationery Office.Google Scholar
Department of Health (2002) Women’s Mental Health: Into the Mainstream (Draft Strategy). Department of Health.Google Scholar
Department of Health (2003a) Mental Health Policy Implementation Guide: Support, Time and Recovery (STR) Workers. Department of Health.Google Scholar
Department of Health (2003b) Mainstreaming Gender and Women’s Mental Health: Implementation Guidance. Department of Health.Google Scholar
Department of Health (2004) Policy Implementation Guide: Community Development Workers for Black and Minority Ethnic Communities (Interim Guidance). Department of Health.Google Scholar
Department of Health (2005) Delivering Race Equality in Mental Health Care: An Action Plan for Reform Inside and Outside Services and The Government’s Response to the Independent Inquiry into the Death of David Bennett. Department of Health.Google Scholar
Department of Health (2010a) Healthy Lives, Healthy People: Our strategy for public health in England. Department of Health.Google Scholar
Department of Health (2010b) A Vision for Adult Social Care: Capable communities and active citizens. Department of Health.Google Scholar
Department of Health (2010c) Equity and Excellence: Liberating the NHS. Department of Health.Google Scholar
Department of Health (2011) No Health without Mental Health: Department of Health – A Cross-Government Mental Health Outcomes Strategy for People of all Ages Mental Health Division. London.Google Scholar
Department of Health (2014) Closing the Gap: Priorities for Essential Change in Mental Health. Department of Health.Google Scholar
Foucault, M. (1967) Madness and Civilization. Tavistock.Google Scholar
Forsythe, B., Melling, J., & Adair, R. (1996) The New Poor Law and the county pauper lunatic asylum: The Devon experience 1834–1884. Soc. Hist. Med, 9, 335–55.Google Scholar
Griffiths, R. (1984) NHS Management Enquiry Report: Social Services Committee. HMSO.Google Scholar
Griffiths, R. (1988) Community Care: Agenda for Action (1988) A Report to the Secretary of State for Social Services by Sir Roy Griffiths. HMSO.Google Scholar
Hall, S. & Jacques, M. eds. (1983) The Politics of Thatcherism. Lawrence and Wishart.Google Scholar
Healthcare Commission (2004) NHS Performance Ratings 2003–4. Commission for Health Care Audit and Inspection.Google Scholar
Hervey, N. (1986) Advocacy or Folly: The Alleged Lunatics’ Friend Society, 1845-63. Medical History 30, 245–75.Google Scholar
Hill, D. (1969) Psychiatry in Medicine: Retrospect and Prospect. Nuffield Provincial Hospitals Trust.Google Scholar
Hills, J. (2015) Good Times Bad Times: The Welfare Myth of Them and Us. Policy Press.Google Scholar
Hilton, C. & Freudenthal, F. (2021) Learning from the past: Inequalities and discrimination in psychiatry’s chequered history. BJPsych Bulletin. https://doi.org/10.1192/bjb.2021.68.Google Scholar
House of Commons (1990) The National Health Service and Community Care Act. HMSO.Google Scholar
House of Commons Social Services Committee (1985) Community Care with special reference to adult mentally ill and mentally handicapped people. (HC 13 1984–5).Google Scholar
Houston, R. A. (1999) ‘Not simple boarding’: Care of the Mentally Incapacitated in Scotland During the Long Eighteenth Century. In Outside the Walls of the Asylum (ed. Bartlett, P. & Wright, D) Athlone Press, pp. 19–44.Google Scholar
HM Government (1990) National Health Service and Community Care Act 1990. Stationery Office.Google Scholar
HM Government (2009) New Horizons: A Shared Vision for Mental Health. Stationery Office.Google Scholar
Jones, K. (1993) Asylums and After: A Revised History of the Mental Health Services: From the early 18th Century to the 1990s. Athlone Press.Google Scholar
Killaspy, H. (2006) Psychiatric out-patient services: Origins and future. Advances in Psychiatric Treatment. 12, 309–19.Google Scholar
Laing, R. D. (1960) The Divided Self. Tavistock.Google Scholar
Laing, R. D. & Esterson, A. (1964) Sanity, Madness and the Family. Tavistock.Google Scholar
Laugharne, R. (2004) Psychiatry in the future: The next 15 years: postmodern challenges and opportunities for psychiatry. Psychiatric Bulletin 28, 317–18.CrossRefGoogle Scholar
MacDonald, M. (1981) Mystical Bedlam. Cambridge University Press.Google Scholar
Mental Health Taskforce (2016) The Five Year Forward View for Mental Health. A Report from the Independent Mental Health Taskforce to the NHS in England. Mental Health Taskforce.Google Scholar
Ministry of Health (1962) A Hospital Plan for England and Wales. Cmnd. 1604. HMSO.Google Scholar
Ministry of Health (1963) Health and Welfare: The Development of Community Care. Cmnd. 1973. HMSO.Google Scholar
Mishra, R. (1990) The Welfare State in Capitalist Society. Harvester Wheatsheaf.Google Scholar
Murphy, E. (2001a) Mad farming in the metropolis. Part 2: The administration of the old poor law of insanity in the City and East London 1800–1834. History of Psychiatry xii, 405–40.Google Scholar
Murphy, E. (2001b) Mad farming in the metropolis. Part 1: A significant service industry in East London. History of Psychiatry xii, 245–282.Google Scholar
Murphy, E. (2002a) The Metropolitan Pauper Farms 1722–1834, The London Journal, 27:1, 1–18. https://doi.org/10.1179/ldn.2002.27.1.1.Google Scholar
Murphy, E. (2002b) The Lunacy Commissioners and the East London Guardians, 1845–1867. Medical History, 2002, 46, 495–524.CrossRefGoogle ScholarPubMed
Murphy, E. (2003) The new Poor Law guardians and the administration of insanity in East London, 1834–1844. Bulletin of the History of Medicine, 77, 1, 45–74.Google Scholar
NHS England (2014) Five Year Forward View. NHS England.Google Scholar
NHS England (2019) The NHS Long Term Plan. NHS England.Google Scholar
Ødegård, O. (1964) Pattern of discharge from Norwegian psychiatric hospitals before and after the introduction of psychotropic drugs. American Journal of Psychiatry 120, 772–8.Google Scholar
Office of Deputy Prime Minister (2004) Mental health and social exclusion. Social Exclusion Unit Report. Office of Deputy Prime Minister.Google Scholar
Organization for Economic Co-operation and Development (OECD) (2016) Society at a Glance 2016: OECD Social Indicators. OECD.Google Scholar
Parry-Jones, W. L. (1972) The Trade in Lunacy. Routledge & Kegan Paul.Google Scholar
Pollock, A. M. (2004) NHS plc: The Privatisation of Our Healthcare. Verso.Google Scholar
Porter, R. (1987) Mind-Forg’d Manacles. Penguin.Google Scholar
Priebe, S. (2021) Patients in mental healthcare should be referred to as patients and not service users. BJPsych Bulletin 45, 6, 327–8. https://doi.org/10.1192/bjb.2021.40.Google Scholar
Ramon, S. (1982) The logic of pragmatism in mental health policy: The implications of the government position on mental health in the 1959 debate for the 80s. Critical Social Policy 2, 38–54.Google Scholar
Report of the Committee of Inquiry into Allegations of Ill-treatment of patients and other irregularities at the Ely Hospital, Cardiff (1969) HMSO.Google Scholar
Richards, V. (2018) The importance of language in mental health care. Lancet Psychiatry. Published online: 23 February 2018. http://dx.doi.org/10.1016/S2215-0366(18)30042-7Google Scholar
Ritchie, J., Dick, D., & Lingham, R. (1994) The Report of the Inquiry into the Care and Treatment of Christopher Clunis. HMSO.Google Scholar
Rollin, H. R. (1977) ‘De-institutionalisation’ and the community: Fact and fiction. Psychological Medicine 7, 181–4.Google Scholar
Rose, N. (2001) Historical changes in mental health practice. In Textbook of Community Psychiatry (eds. Thornicroft, G. and Szmukler, G.). Oxford University Press, pp. 13–27.Google Scholar
Rosenhan, D. I. (1973) On being sane in insane places. Science 179, 250–8.Google Scholar
Sainsbury Centre for Mental Health (2003) Money for Mental Health. Sainsbury Centre for Mental Health.Google Scholar
Sayce, E., Craig, T. K. J., & Boardman, A. P. (1991) Community mental health centres in the United Kingdom. Social Psychiatry Psychiatric Epidemiology. 26, 14–20.Google Scholar
Scull, A. T. (1979) Museums of Madness. Allen Lane.Google Scholar
Sedgwick, P. (1982) Psycho Politics. Pluto PressGoogle Scholar
Sedgwick, P. (1983) The fate of psychiatry in the new populism. Bulletin of the Royal College of Psychiatrists 7, 2, 22–5.Google Scholar
Shepherd, M., Goodman, S., & Watt, D. C. (1961) The application of Hospital Statistics in the evaluation of pharmacotherapy in a psychiatric population. Comprehensive Psychiatry 2, 1–9.Google Scholar
Sturdy, H. & Parry-Jones, W. (1999) Boarding out insane patients: The significance of the Scottish system 1857–1913. In Outside the Walls of the Asylum (ed. Bartlett, P. & Wright, D.). Athlone Press, pp. 86–114.Google Scholar
Susser, E., Baumgartner, J. N., & Stein, Z. (2010) Commentary: Sir Arthur Mitchell – pioneer of psychiatric epidemiology and of community care. International Journal of Epidemiology 39:1417–25.CrossRefGoogle Scholar
Szasz, T. S. (1961) The Myth of Mental Illness. Secker and Warburg.Google Scholar
Titmuss, R. (1961) Community care: Fact or fiction? (Annual conference Report, National Association for Mental Health). Reprinted in Titmuss, R. (1976), Commitment to Welfare, 2nd ed. Allen & Unwin, pp. 104–9.Google Scholar
Thornicroft, G. & Bebbington, P. (1989) Deinstitutionalisation–from hospital closure to service development. British Journal of Psychiatry 155, 739–53.CrossRefGoogle ScholarPubMed
Thornicroft, G. & Tansella, M. (2004) Components of a modern mental health service: A pragmatic balance of community and hospital care. British Journal of Psychiatry 185, 283–90.CrossRefGoogle ScholarPubMed
Tyrer, P., Sharfstein, S., O’Reilly, R., Allison, S., & Bastiampillai, T. (2017) Psychiatric hospital beds: An Orwellian crisis. Lancet 389, 363.Google Scholar
Wilkinson, R. G. (1996) Unhealthy Societies: The Afflictions of Inequality. Routledge.Google Scholar
Wilkinson, R. & Pickett, K. (2009) The Spirit Level: Why More Equal Societies Almost Always Do Better. Penguin.Google Scholar

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