Introduction

It is a truism to state that mental health services operate within the context of policy. While health policy has, at various times, gone through cycles of support for growth and investment in mental health services, mental health rehabilitation services have repeatedly had to state the case for their continued existence. In this chapter, we describe this process, focusing on the past decade or so. At its core, this narrative has an unsettling message for rehabilitation practitioners: that policy-makers are only too ready to marginalise people with the most complex mental health problems in the mistaken belief that the latest approach to reorganising services will magically negate the need for mental health rehabilitation. Understanding how to influence policy is a key skill for clinical leaders in mental health rehabilitation and we hope that this chapter will provide an insight and resources into how this can be achieved.

A brief history

Earlier chapters have described in some detail the process of deinstitutionalisation of mental health services in England and Wales in the latter half of the 20th century, and similar activities were carried out in many other high-income countries across the world around the same time. This was a period of relative ‘boom’ for rehabilitation services, with many of those practising in this discipline being heavily involved in the process of assessment and the ‘resettling’ of patients in supported accommodation in the community. The first community rehabilitation teams developed around this time to provide ongoing support to this cohort of patients. The outcomes reported by the Team for the Assessment of Psychiatric Services (TAPS) were very positive; most of those who had been long-stay patients in an institution who moved to a community placement did not relapse or require readmission to hospital (Leff & Trieman, 2000) and around twothirds of those considered the least suitable for community placement not only remained stable in the community but were able to move on to less supported accommodation within 5 years (Trieman & Leff, 2002).