ABSTRACT
A number of inter-related themes have underpinned the development of psychiatry during the twentieth century. First, its influence and activities have spread beyond the asylum. The structure of mental health services has been transformed from the large-scale nineteenth century custodial asylums, set apart from the community, to incorporate a diverse range of publicly funded services within the community (Busfield, 1986, 1996). However, the extent to which the transition from institutional to community psychiatry has been adequately supported by appropriate organizational and financial resources continues to be a matter of debate. Second, the focus of psychiatric theory and practice has become increasingly diverse, both in terms of the type of problem receiving attention and the character of those being treated. There has been a broadening of categories of mental disorder, in particular the psychoneuroses, and a concentration on acute rather than chronic problems. This has been accompanied by a growth in voluntary ‘therapeutic’ relationships rather than coercive treatment; an increasing emphasis on mental health as a public health issue; and a mushrooming industry in ‘alternative’ models of intervention such as counselling and psychotherapy (Pilgrim and Rogers, 1993). Third, and closely related to the last point, is the diversity of other mental health professions which have emerged throughout the century. Although in law it is the psychiatrist who has primary clinical responsibility for the care and treatment of the mentally disordered, to a great extent this professional dominance has been constrained by the development of the psychiatric team with its eclectic range of skills in psychiatry, psychology, social work, nursing and occupational therapy.
