In Chapter 3 we noted that, during Victorian period, mad-doctors and lay administrators of asylums generated a rhetoric of therapeutic optimism in which they made inflated claims of cure. Since then, a dilemma which has dogged those professionally responsible for madness and psychological distress relates to their credibility. Put simply, what can be reasonably expected of mental health professionals? This is a global question for governments, since they all need to contain expenditure on health and social services. Cost minimisation or cost-effectiveness have become hallmarks of health service management throughout the world.
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