ABSTRACT
There has been any number of books and articles delineating the shift from institutional care, associated with the old asylums and held to be oppressive and dehumanising, to something called 'community care', or 'care in the community'. As is well known, a policy of helping all but the most extremely disabled live in a sometimes idealised 'community' replaced the old institutions. There were many positive aspects to the changes in mental health policy and provision; the wish to work in a more holistic and joined-up way, integrating psychiatric and social care, the need for consistent and coherent treatment models linked to research and best evidence, the desire for the patient to be at the centre of treatment and to have a voice in this, and the provision of treatment that would involve the least restrictive option. In line with the incursion of market forces and consumer models of human relating, patients were offered 'packages of care', rather than 'treatment'.
