Mental health service provision in England.
OBJECTIVE
To describe mental health service provision for adults of working age in England.


METHODS
Services in an inner London area are described so as to illustrate current patterns of service organization in England. National trends are then discussed.


RESULTS
Despite relatively low public expenditure, substantial progress has been made in deinstitutionalization and development of comprehensive community-based services. Persisting difficulties include high staff turnover, a minority of patients. who do not engage with community services, user and carer dissatisfaction with emergency services, and social exclusion because of stigma. Recent government policy advocates resolving some of these problems using new service models such as assertive outreach and crisis teams.


CONCLUSIONS
Closure of the large asylums has largely been accomplished. England is now entering a new phase in community service development, with a range of innovative developments aimed at resolving problems still encountered after the initial phases of integrated community service development.
Johnson
S
S
Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, UK. s.johnson@ucl.ac.uk
Zinkler
M
M
Priebe
S
S
D000328:Adult; D000368:Aged; D004739:England; D006801:Humans; D008131:London; D008605:Mental Health Services / Q000458:organization & administration* / Q000639:trends; D008875:Middle Aged; D012111:Residence Characteristics