Writing about UK psychiatric services is difficult - it is like trying to hit a moving target. There is constant change, and increasing differences between England, Wales, Scotland, and Northern Ireland. Recently, 'modernization' seems to have been viewed by the government as the same thing as improvement. Huge amounts of money have been wasted on extra administrators, 'management consultants', and bumbling attempts to set up a national NHS information technology network without a clear idea of what it is for. The latest 'good ideas' have been introduced into clinical practice without proper trial, and without adequate resources (i.e. 'from existing resources').
In spite of these continuing top-down difficulties imposed on the system, psychiatry remains an enthralling specialty. Surviving in it depends on a continuing interest in patients as individuals, and also on the ability to work as part of a team - because it is through teams that psychiatry is now generally practised. These teams are largely based in the community. I will start with a description of the community mental health team, as this seems likely - at any rate, for the time being - to remain the foundation stone of psychiatric services. However, it is first necessary to say a few words about the historical background, as otherwise it is difficult to understand the pattern of existing mental health services.
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