Introduction

Nottingham has followed an evolutionary path in the development of community psychiatric services. The present structure was heralded by innovations introduced during the 1950s and 1960s by Dr Duncan Macmillan, who was then superintendent of Mapperley Hospital. He began the process of discharging large numbers of long-stay patients who were living in the hospital by placing them in residential homes throughout various parts of the city. The unlocking of all wards areas in 1958 resulted in the acute admission services adapting their way of working to patterns which later facilitated the present concepts of community psychiatry (MacMillan, 1963).

The outward movement of patients led to the development of day facilities which initially functioned as Occupational Therapy departments for the long-term mentally ill. In time, acute day hospitals developed and began to take over some of the functions previously undertaken by acute wards. The first dedicated community Mental Health Centre was opened in the early 1980s and subsequently there has been a gradual extension of these services to all areas of the city.

Present services

The mental health needs of the City of Nottingham are to a large extent provided by the mental health unit, with limited private practice facilities. The district covers a population of areas in a wedge-shaped fashion so that each contains a part of the inner city. The catchment areas or sectors are served by a mental health team which has a community base from which the local psychiatric service is organised.