Tom Bromwich General Manager

From the Poor Law to New Horizons History of Mental Health Care in England

1601 Poor Law Introduced a clear responsibility for every Parish to support those who were incapable of looking after themselves. Perhaps an early root for the association of poverty and disability. Further legislation in 1834 led to the building of the Workhouses

This act required Counties to provide asylums this lead in the following years to the building of the majority of Britain’s psychiatric hospitals. The growth was fuelled by funding arrangements which encouraged Parishes to move people into Asylums. Thus the large psychiatric institutions were born The Lunacy Act

First central government funding for health or social care was introduced with subsidy of “pauper lunatics” in asylums. 1875

Suggested that out patient clinics be developed, concept of voluntary admission to psychiatric hospital and concept of prevention and treatment rather than detention was introduced Royal Commission on Lunacy and Mental Disorder

Terms such as Pauper Lunatic were abolished and 1930s generally sees development of out patient and social work provision Amendments to Poor Law

Introduced a duty on local authorities to provide residential accommodation for persons who due to age, illness or disability where this was not otherwise available to them. This begins a move towards community based care National Assistance Act

1954 Peak of inpatients in Psychiatric Hospitals

Stated that large psychiatric institutions should close and local authorities should develop community services Hospital Plan for England and Wales

First large psychiatric hospital closes but it was only by the early 1990’s that majority of larger institutions had closed. 1986

The Act made discrimination against people due to their disability illegal and required employers to make reasonable adjustments in work place. There are some weaknesses in the act relating to mental illness. DDA is amended in 2005 to remove the emphasis on clinically well defined mental illness Disability Discrimination Act

“care in the community has failed………many vulnerable patients left to cope on their own” Not all agreed that the policy had failed but evidence suggested that closure of institutions and re assimilation of people into society had been poorly planned and executed Health Secretary states

National standards for mental health services are defined National Service Framework

This document underlines the importance of work and its role in social inclusion. Direction of travel away from investment in day services and into supporting people to return to work Mental Health and Social Inclusion

Report on depression and anxiety which recommends the use of psychological therapies on economic grounds. This is now the NHS Increasing Access to Psychological Therapies programme available through self referral or through General Practitioners Layard Report

The Government introduced changes in Incapacity Benefit [a passive benefit for people with disabilities] into Employment Support Allowance [ESA] which requires some people who may be able to work with the appropriate support to engage on mandatory work focussed activity. The package of support introduced is the Pathways to Work programme. The Government have had in place for a number of years a programme called Workstep which supported people to return to work but on a voluntary basis ESA & Pathways to Work

New Horizons is a policy document which sets out strategies for the Mental Wellbeing of our population. It starts with education of children in our schools around mental wellbeing, strategies for healthy work places, support for people with mental health issues in gaining and sustaining work. But………….new government has put aside this policy and we await their policy views, 2010 New Horizons

Recovery practice assumes that irrespective of continuing mental health issues people can have purposeful and fulfilling lives but this depends upon a different relationship between those experiencing psychological distress and those providing medical, social and employment support. A change from power and control to co production. Recovery Movement

The recovery approach is based on three key principles - hope, control, and opportunities - and that successful implementation demands a radical change in staff attitudes to mental illness and to those experiencing it. Health and social care provision [NHS] in Devon are at the fore front of recovery thinking. Employment is a core aspect of recovery. Please see Recovery Movement cont.