From the asylum to community care: learning from experience

Abstract

A review of research and policy on community care was carried out. The methods used included the following: (i) Medline search using terms: 'mental health' and 'community care and long-term conditions' and 'community care'; (ii) Searches of the Department of Health and the Royal College of Psychiatrists' websites using the term 'community care' and (iii) hand search of historical texts on the development of community care. Medline searches returned 349 titles in total. Inclusion criteria were quality and relevance to other specialties. Policy material was included to illustrate the socio-political context of the development of community services. Community care was consistently associated with greater patient satisfaction and quality of life across specialties. It was not a cheaper alternative to hospital care. Disadvantages included the exodus of experienced inpatient staff to community settings and the development of alternative institutions in the non-statutory sector. Those planning community-based care for physical health problems should learn from the experience of mental health services.