European nations – including Britain – have a common pattern in their history of mental health care. Most western and central European countries established large asylums in the 19th century and engaged in some form of de-institutionalisation during the second half of the 20th century. Since the 1950s, major mental health reforms have significantly improved the quality of care. Although time of onset, pace, fashion and outcomes of reforms varied greatly between countries, throughout western Europe community-based services have been established and become part of routine service provision (Becker & Vázquez-Barquero, 2001). Compared with the heyday of the reform spirit in the 1970s, we now appear to be experiencing a relatively calm period. Developments currently seem to be dominated by fragmented pragmatism rather than by dreamy visions. This may reflect a wider trend in politics: throughout Europe, ambitious long-term visions appear less relevant as drivers for political change than was the case a few decades ago.
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