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Community psychiatry's achievements

  • T. Burns (a1)


Mental health care in the second half of the 20th century in much of the developed world has been dominated by the move out from large asylums. Both in response to this move and to make it possible, a pattern of care has evolved which is most commonly referred to as ‘Community Psychiatry’. This narrative review describes this process, from local experimentation into the current era of evidence-based mental health care. It focuses on three main areas of this development: (i) the reprovision of care for those discharged during deinstitutionalisation; (ii) the evolution and evaluation of its characteristic feature the Community Mental Health Team; and (iii) the increasing sophistication of psychosocial interventions developed to support patients. It finishes with an overview of some current challenges.


Corresponding author

Address for correspondence: Professor Tom Burns, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX. (Email:


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Alec, B, Renée, LB, Michael, N, Marvin, S (2012). Psychiatric violence risk assessment. American Journal of Psychiatry 169, 340.
Bachrach, LL (1976). Deinstitutionalization: An Analytical Review and Sociological Perspective. US Department of Health, Education and Welfare, NIMH: Rockville, USA.
Bachrach, LL (1996). Lessons from America: semantics and services for mentally ill homeless individuals. In Homelessness and Mental Health (ed. Bhugra, D), 230243. Cambridge University Press: Cambridge.
Barton, R (1959). Institutional Neurosis. John Wright: Bristol.
Bond, GR, Drake, RE, Becker, DR (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal 31, 280290.
Braun, P, Kochansky, G, Shapiro, R, Greenberg, S, Gudeman, JE, Johnson, S, Shore, MF (1981). Overview: deinstitutionalization of psychiatric patients, a critical review of outcome studies. American Journal of Psychiatry 138, 736749.
Burns, T (2009). End of the road for treatment-as-usual studies? British Journal of Psychiatry 195, 56.
Burns, T, Catty, J, Dash, M, Roberts, C, Lockwood, A, Marshall, M (2007). Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. British Medical Journal 335, 336.
Catty, J, Burns, T, Knapp, M, Watt, H, Wright, C, Henderson, J, Healey, A (2002). Home treatment for mental health problems: a systematic review. Psychological Medicine 32, 383401.
Colom, F, Vieta, E, Martinez-Aran, A, Reinares, M, Goikolea, JM, Benabarre, A, Torrent, C, Comes, M, Corbella, B, Parramon, G (2003). A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Archives of General Psychiatry 60, 402407.
Craig, TK, Garety, P, Power, P, Rahaman, N, Colbert, S, Fornells-Ambrojo, M, Dunn, G (2004). The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal 329, 10671070.
Creed, F, Black, D, Anthony, P, Osborn, M, Thomas, P, Tomenson, B (1990). Randomised controlled trial of day patient versus inpatient psychiatric treatment. British Medical Journal 300, 10331037.
Creed, F, Black, D, Anthony, P, Osborn, M, Thomas, P, Franks Polley, R, Lancashire, S, Saleem, P, Tomenson, B (1991). Randomised controlled trial of day and in-patient psychiatric treatment. 2: comparison of two hospitals. British Journal of Psychiatry 158, 183189.
Dixon, LB, Lehman, AF (1995). Family interventions for schizophrenia. Schizophrenia Bulletin 21, 631643.
Fioritti, A, Lo, RL, Melega, V (1997). Reform said or done? The case of Emilia–Romagna within the Italian psychiatric context. American Journal of Psychiatry 154, 9498.
Gaebel, W, Becker, T, Janssen, B, Munk-Jorgensen, P, Musalek, M, Rössler, W, Sommerlad, K, Tansella, M, Thornicroft, G, Zielasek, J (2012). EPA guidance on the quality of mental health services. European Psychiatry 27, 87113.
Goffman, I (1960). Asylums: Essays on the Social Situation of Mental Patients and other Inmates. Penguin Books: Harmondsworth, Middlesex.
Greenwood, RM, Schaefer-Mcdaniel, NJ, Winkel, G, Tsemberis, SJ (2005). Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. American Journal of Community Psychology 36, 223238.
Hirsch, SR, Platt, S, Knights, A, Weyman, A (1979). Shortening hospital stay for psychiatric care: effect on patients and their families. British Medical Journal 1, 442446.
Howes, O (2014). Cognitive therapy: at last an alternative to antipsychotics? Lancet 383, 13641366.
Jauhar, S, Mckenna, P, Radua, J, Fung, E, Salvador, R, Laws, K (2014). Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. British Journal of Psychiatry 204, 2029.
Johnson, S, Thornicroft, G (1993). The sectorisation of psychiatric services in England and Wales. Social Psychiatry and Psychiatric Epidemiology 28, 4547.
Johnson, S, Nolan, F, Pilling, S, Sandor, A, Hoult, J, Mckenzie, N, White, IR, Thompson, M, Bebbington, P (2005). Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. British Medical Journal 331, 599.
Keown, P, Weich, S, Bhui, KS, Scott, J (2011). Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988–2008: ecological study. British Medical Journal 343, 196204.
Knapp, M, Hallam, A, Beecham, J, Baines, B (1999). Private, voluntary or public? Comparative cost-effectiveness in community mental health care. Policy and Politics 27, 2541.
Leff, J, Kuipers, L, Berkowitz, R, Eberlein-Vries, R, Sturgeon, D (1982). A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry 141, 121134.
Leff, J, Berkowitz, R, Shavit, N, Strachan, A, Glass, I, Vaughn, C (1990). A trial of family therapy versus a relatives' group for schizophrenia. Two-year follow-up. British Journal of Psychiatry 157, 571577.
Mangen, SP (1985). Psychiatric policies: development and constraints. In Mental Health Care in the European Community (ed. Mangen, SP), 133. Croom Helm: London.
Maughan, D, Molodynski, A, Rugkåsa, J, Burns, T (2013). A systematic review of the effect of community treatment orders on service use. Social Psychiatry and Psychiatric Epidemiology, 113. DOI: 10.1007/s00127-013-0781-0.
Mueser, KT, Bond, GR, Drake, RE, Resnick, SG (1998). Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin 24, 3774.
Mullen, PE (2000). Forensic mental health. British Journal of Psychiatry 176, 307311.
O'Donnell, C, Donohoe, G, Sharkey, L, Owens, N, Migone, M, Harries, R, Kinsella, A, Larkin, EO (2003). Compliance therapy: a randomised controlled trial in schizophrenia. British Medical Journal 327, 834.
Petersen, L, Jeppesen, P, Thorup, A, Abel, MB, Ohlenschlaeger, J, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2005). A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331, 602.
Pilling, S, Bebbington, P, Kuipers, E, Garety, P, Geddes, J, Martindale, B, Orbach, G, Morgan, C (2002). Psychological treatments in schizophrenia. II. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation. Psychological Medicine 32, 783791.
Priebe, S, Hoffmann, K, Isermann, M, Kaiser, W (2002). Do long-term hospitalised patients benefit from discharge into the community? Social Psychiatry and Psychiatric Epidemiology 37, 387392.
Priebe, S, Badesconyi, A, Fioritti, A, Hansson, L, Kilian, R, Torres-Gonzales, F, Turner, T, Wiersma, D (2005). Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. British Medical Journal 330, 123126.
Priebe, S, Burns, T, Craig, TK (2013 a). The future of academic psychiatry may be social. British Journal of Psychiatry 202, 319320.
Priebe, S, Yeeles, K, Bremner, S, Lauber, C, Eldridge, S, Ashby, D, David, AS, O'CONNELL, N, Forrest, A, Burns, T (2013 b). Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial. British Medical Journal 347, 1121.
Rugkåsa, J, Dawson, J (2013). Community treatment orders: current evidence and the implications. British Journal of Psychiatry 203, 406408.
Salize, HJ, Dressing, H (2004). Epidemiology of involuntary placement of mentally ill people across the European Union. British Journal of Psychiatry 184, 163168.
Salize, HJ, Rössler, W, Becker, T (2007). Mental health care in Germany. European Archives of Psychiatry and Clinical Neuroscience 257, 92103.
Sartorius, N, Jablensky, A, Shapiro, R (1977). Two-year follow-up of the patients included in the WHO International Pilot Study of Schizophrenia. Psychological Medicine 7, 529541.
Sjöström, S, Zetterberg, L, Markström, U (2011). Why community compulsion became the solution – reforming mental health law in Sweden. International Journal of Law and Psychiatry 34, 419428.
Slade, M (2009). Personal Recovery and Mental Illness: A Guide for Mental Health Professionals (Values-Based Practice). Cambridge University Press: Cambridge, UK.
Stein, LI, Test, MA (1980). Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry 37, 392397.
Sytema, S, Micciolo, R, Tansella, M (1997). Continuity of care for patients with schizophrenia and related disorders: a comparative South-Verona and Groningen case-register study. Psychological Medicine 27, 13551362.
Talbott, JA, Clark, GH Jr., Sharfstein, SS, Klein, J (1987). Issues in developing standards governing psychiatric practice in community mental health centers. Hospital and Community Psychiatry 38, 11981202.
Thornicroft, G, Farrelly, S, Szmukler, G, Birchwood, M, Waheed, W, Flach, C, Barrett, B, Byford, S, Henderson, C, Sutherby, K, Lester, H, Rose, D, Dunn, G, Leese, M, Marshall, M (2013). Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial. Lancet 381, 16341641.
Torrey, EF (1997). Out of the Shadows: Confronting America's Mental Ill-ness Crisis. John Wiley: New York.
Trieman, N, Leff, J, Glover, G (1999). Outcome of long stay psychiatric patients resettled in the community: prospective cohort study. British Medical Journal 319, 1316.
Turkington, D, Kingdon, D, Turner, T (2002). Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. British Journal of Psychiatry 180, 523527.
Turkington, D, Kingdon, D, Rathod, S, Hammond, K, Pelton, J, Mehta, R (2006). Outcomes of an effectiveness trial of cognitive-behavioural intervention by mental health nurses in schizophrenia. British Journal of Psychiatry 189, 3640.
Vaughn, CE, Leff, JP (1976). The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry 129, 125137.
Wolff, G, Pathare, S, Craig, T, Leff, J (1996). Community knowledge of mental illness and reaction to mentally ill people. British Journal of Psychiatry 168, 191198.
World Health Organisation (1973). Report of the international pilot study of schizophrenia.
Wright, C, Catty, J, Watt, H, Burns, T (2004). A systematic review of home treatment services. Classification and sustainability. Social Psychiatry and Psychiatric Epidemiology 39, 789796.
Zinkler, M, Priebe, S (2002). Detention of the mentally ill in Europe – a review. Acta Psychiatrica Scandinavica 106, 38.


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Community psychiatry's achievements

  • T. Burns (a1)


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