ABSTRACT

The context for the practice of social work and community psychiatric nursing (CPN) as well as the development of community mental health centres (CMHC) is provided by the increasing emphasis since 1945 on community care of the mentally ill. To a large degree this arose from the development of psychotropic drugs in the 1950s, which revolutionized the control of major mental illness, such as schizophrenia, creating an atmosphere of therapeutic optimism. This was allied to a growing disenchantment with hospitals as an appropriate setting for managing mental illness, and the potential debilitating effect of institutional care (Goffman, 1961). The term ‘institutional neurosis’ described a process by which hospital regimes created individuals with characteristics such as submissiveness, apathy and a shuffling gait (Barton, 1959). Closely associated with this was the preferred notion of ‘normalization’: ‘The conviction that if people with handicaps are treated like everyone else, their handicaps will cease to be of importance to them and to society’ (Jones, 1988, p. 90). In political terms the focus for decarceration of patients was most evident in Powell’s well known speech as Minister of Health planning to halve the number of hospital beds in fifteen years (Powell, 1961), which was followed by the ‘Hospital Plan’, which envisaged the run down and eventual closure of existing hospitals and their replacement by short stay psychiatric units and community care facilities provided by local authorities (Ministry of Health, 1962). Figures for bed occupancy reflect the subsequent reduced emphasis on institutional care: average daily bed occupancy reduced from 118,800 in 1966 to 83,800 in 1976 and 61,500 in 1986 (Department of Health, 1988).