ABSTRACT
People with long-term and complex needs require services which integrate health and social care assessments and care packages, often from each of the so-called primary, secondary and tertiary services. Public health doctors saw the problem as a public health issue, and focused on the fact that the bulk of disorder is in the community or at primary care level. The Darlington Project suggests that both horizontal and vertical integration and collaboration are critical to the success of community care. Alternative concepts are needed which are more obviously related to the integration of health and social care needs, are independent of location, and are a more realistic reflection of the mixed economy of welfare. In spite of much publicity, training programmes, and feedback to general practitioners, the performance of primary care in adequately assessing and treating patients with mental illness remains very much as it was in the late 1970s, when this model was quantified.
