It came as a shock to me, after many years planning to be a psychiatrist and a couple of years as an enthusiastic but naive trainee, to read a Lancet editorial entitled 'Psychiatry: a discipline that has lost its way ' (Lancet, 1985). Since then my experience and reading, as a sadder and little bit wiser clinician, have convinced me that this editorial was spot on. After the Asylums by Professor Elaine Murphy is, to date, the best available guide for British psychiatrists and other mental health professionals who are trying to find a way forward for their discipline.
Professor Murphy clearly agrees with the Lancet editorialist. After a useful sketch of the rise and decline of the asylum movement, she moves on to recent developments in the care of the chronically mentally ill and provides us with a chapter that could stand alone as a truly brilliant critique of a mental health care system that has gone hopelessly wrong. She maintains that:
we can trace the failure of community care for mentally disordered people to political neglect, detrimental NHS and local authority organizational changes, loss of local government power, financial disincentives to effective delivery of care, the increasing need for resources by an ageing population and, last, the failure by psychiatrists in the development of services for people who need long-term care.