Improving community mental health services: The need for a paradigm shift

Background: It is now over half a century since community care was introduced in the wake of the closure of the old asylum system. This paper considers whether mental health services,regardless of location,can be genuinely effective and humane without a fundamental paradigm shift. Data: A summary of research on the validity and effectiveness of current mental health treatment approaches is presented. Limitations: The scope of the topic was too broad to facilitate a systematic review or meta-analyses,although reviews with more narrow foci are cited. Conclusions: The move to community care failed to facilitate a more psychosocial,recovery-focused approach,instead exporting the medical model and its technologies,often accompanied by coercion,into a far broader domain than the hospital. There are,however,some encouraging signs that the long overdue paradigm shift may be getting closer.