Mental Health in the 1990s: from Custody to Care?

Mental distress or dysfunction serious enough to be regarded as illness is a common experience. In the United Kingdom four to five million people a year consult their family doctors because of conditions such as depression and anxiety. Perhaps as many again suffer similar symptoms but either do not seek medical help, or are not identified as being psychiatrically disturbed. A central objective of this OHE publication is to assess what essential service elements the nation's mental health care system should be able to offer, and to evaluate the barriers to, and opportunities for, their achievement. It outlines, first, the nature and scale of four of the main groups of mental health problems affecting the UK population. (Topics such as the harm caused by illegal drug use and alcohol related conditions are not touched on in detail, although OHE has considered them elsewhere - see, for instance, Taylor 1981.) Second, the paper traces the development of the mental health and social care provisions available in Britain. Third, it discusses the place that medicines, alongside psychological and social approaches, have to play in this context. And, fourth, it examines the prospects for future improvements in care. Throughout the paper emphasis is given to the need to combine social, psychological and biomedical knowledge to help generate unified and realistic understandings of mental health problems and the ways available to ease them. This is because one of the central lessons this study has to offer is that a lack of appropriate communication between professionals who should be sharing their complementary knowledge and skills, coupled with failures to listen to the experiences and ideas of mentally distressed people and their informal carers, lies at the heart of many service provision problems. Fragmentation, conflict and disillusion at the 'grass roots' promotes general public and political distrust, which all too often feeds back via inadequate resource availability for research and for care. Breaking such cycles of self-sustaining distress and defeat is a central task for everyone involved in mental health care today, at both individual and societal levels.