As we noted in Chapters 3 and 4, mental health care over the last two centuries has been dominated by the rise and fall of the asylum. Moving from institutional to community settings has triggered a whole new mental health enterprise called ‘community care’ or ‘care in the community’. In some ways, the idea of community care in mental health ran counter to the dominant trend within the NHS after 1948, which, until recently, was centralised and hospital-dominated. Latterly, ‘community care’ has been an emotive term within a policy context. It has tended to draw venom and passion in equal amounts from both policy-makers and commentators. On the positive side community care has held out the promise of a humanitarian solution to oppressive institutions. On the negative side, ‘the community’ has been seen as a dustbin into which all but the most dramatically dangerous, and hence politically embarrassing for society, problems can be dropped. Such strong contrary views have been influential in both driving and retarding full de-institutionalisation and an enlargement of citizenship for people with mental health problems.
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