Psychiatry in the National Health Service 1948-1998

Background The 50th anniversary of the inauguration of the NHS provided the occasion to review the evolution of mental health services and of psychiat ry itself in Britain during that period. Aims The principal themes to be followed were the decline of a mental hospi tal system that had existed for over a century, the development of an alter native policy of 'community care', the emergence of a numerous and well-tra ined psychiatric profession, and the interaction between political and lega l processes and mental health care. Method An examination of Ministry of Health and Department of Health and So cial Security files in the Public Record Office, interviews with influentia l figures, examination of the secondary literature, and personal experience of events described. Results The material has been analysed, in the light of the expressed aims. and important trends have been described. The current situation is assesse d. Conclusions The replacement of one system of care and treatment in Britain by another has been a process fraught with overwhelming difficulties. While adhering to the aim of 'community care', governments have been reluctant t o provide the means for achieving this. The psychiatric profession is now f aced with very large but ill-defined responsibilities. Declaration of interest None.