This is a tale of two systems – the systems of care for people with mental illness in Britain and the USA. Although both the authors are British-trained, one (JL) has practised social and community psychiatry in the UK and the other (RW) in the USA. We have both, however, had ample opportunity to visit the service systems in these two countries and in many others around the world. This exposure to different systems of care has allowed us to present quite a broad range of experiences and models to the reader, but, here and there, it may have introduced a note of confusion.

In Britain, for example, the current term for someone who has experienced an episode of mental illness and has received mental health services is a ‘service-user’ or ‘user’. In the USA, the term is ‘consumer’. After struggling with this for a while, we gave up and left you, the reader, to sort it out. Just remember: service-user = user = consumer.

More complicated is the fact that the systems in which we have worked in Britain and the USA developed quite differently after the Second World War, and so the models of treatment and rehabilitation that we have helped to develop were designed to respond to different problems. This is an important lesson in itself. The treatment approaches and models that we describe in this book did not happen in a vacuum – they are responses to specific conditions.