Preface

Summary

The 25 years from 1955 was the period when psychiatry came of age. Effective medications for the common mental disorders, such as schizophrenia and the affective and anxiety disorders, became generally available for the first time. Community attitudes towards the mentally ill, and the confidence of patients being treated with the new drugs, enabled people in many countries who would otherwise be nursed in hospital to live in the community and receive their treatment there. The focus of psychiatry moved to the general hospital and to ambulatory care, exactly as in the rest of medicine. Primary care physicians were increasingly expected to recognize and manage people with mental disorders, exactly as they did for people with physical disorders. Psychiatry and the mental health services felt excited and were exciting.

A series of epidemiological studies published in the 1960s showed that the number of people in the community who met criteria for a mental disorder far exceeded the number who were receiving attention from the specialist mental health services, from primary care physicians, or from any other segment of the health service. It was not that the majority of those untreated were afflicted only by mild or transient disorders, for in some studies significant numbers of people with serious and disabling mental disorders went untreated. The introduction of the psychotropic drugs and the move to community care had been politically easy – both steps saved money for either the state or the private insurer. Attempts to widen the reach of mental health services were not easy for, it was claimed, it would not be cost-effective to invest more health dollars in mental health unless it were to pay for cost-effective treatments.