Introduction

The change in emphasis from institution-based psychiatry to mental health care based in the community is affecting services across Europe and North America, and involves a change in ways of thinking about health and illness. Essentially it means a shift from ‘symptomsthinking’ to ‘needs-thinking’, from looking for illness to promoting health. This transformation is foreshadowed in changes in the language used in many circles and attempts to look anew at the ideologies and concepts that inform the development of services as indicated in recent policy documents (MIND, 1993a, 1993b) and papers (Cobb, 1993; Wood, 1993; Darton et al., 1994) issued by the National Association for Mental Health (MIND). The term ‘mental health problem’ has replaced, to some extent, ‘mental illness’; people formerly called ‘patients’ are increasingly referred to as ‘service users’; and rather than (psychiatric) treatments, ‘interventions’ are planned-with the totality being subsumed within the concept of promoting ‘mental health care’, not the eradication of ‘mental illness’. There is much more talk about services based on needs-assessment (rather than diagnosis), and multi-disciplinary community teams are being seen as the basis of mental health services, with the (medical) general practitioner and hospital-based psychiatrist being one of a team and not necessarily its leader. The government’s White Paper Caring for People (DHSS, 1993) sees the assessment of need as a ‘cornerstone of community care’. In the midst of all this, one hears and reads about the need to address the diversity of need in a multicultural society, and about the inequities caused by racism.