1601    The Poor Law was introduced and clearly defined the responsibility of every parish to support those who were incapable of looking after themselves. This responsibility was limited to people born or defined as being 'settled' in a parish. Other people who did not fit these categories could be expelled from the parish.

1808    The County Asylums Act gave permissive powers to the Justices of each county to build asylums, paid for by local rates, to replace the few psychiatric annexes to voluntary general hospitals. However this development was very slow.

1834    The Poor Law Amendment Act required relief to be provided within institutions only. This led to the construction of a huge network of workhouses.

1845    The Lunacy Act required counties to provide asylums. The majority of Britain's psychiatric hospitals were built during the next 25 years. The growth of asylums was fuelled by funding arrangements that encouraged local parishes to move the parish poor into asylums, as these were funded by the county councils not the parishes.

1860s    The workhouses were obliged to build 'infirmary' annexes – the first general hospitals.

1863    Mental After-Care Association (MACA) established: a voluntary organisation providing short-stay residential homes for discharged psychiatric patients in the Greater London area.

1875    The government began to pay a subsidy to Poor Law authorities of up to 25 per cent of the cost of supporting 'pauper lunatics' in asylums. This was the first central government financing of any health or social care service.

1880    The second wave of asylum building began.

1890    The Lunacy Act (1890) brought in laws regulating asylums and compulsory care.

1891    The Lunacy Act (1891) imposed rigid procedures and criteria so that only people with the most severe mental illnesses were likely to be admitted to hospitals.

1909    A report of the Poor Law Commission was published, based around two central principles:

• in terms of healthcare, that prevention is cheaper and more effective than cure

• in terms of social care, that charitable activity has its proper place in supporting a public service.

The report also suggested that the Poor Law should be replaced by specialised social services dealing with separate categories of people. The subsequent development of the National Health Service (NHS) and local authority social services can be seen in terms of these principles.

1923    The Maudsley Hospital was opened by London County Council. It was the first psychiatric hospital to operate outside the restrictions of the Lunacy Act.

1923    The Tavistock Clinic was founded as a centre for psychotherapeutic training and treatment.

1926     A Royal Commission recommended that mental illness should be dealt with along modern public health lines.

1930    Reform of the Poor Law. Terms such as 'pauper lunatic' were abolished. Out-patient work by the medical staff of public mental hospitals was permitted.

Legislation brought the workhouse infirmaries under the control of local authorities. More of these progressed towards becoming general hospitals. Many had observation wards where patients were admitted under the Lunacy Act, while others had long-stay wards for non-acute psychiatric patients.

1930     The Mental Treatment Act (1930) allowed for voluntary admission to psychiatric hospitals.

1930s    The 1930s saw the introduction of physical treatments, such as electro-convulsive therapy (ECT), lobotomy and insulin coma treatment, allowing the early discharge of some people back to the community. By 1936, 143 out-patient clinics were operating, some of which had social workers attached to them.

1939    The Feversham Committee on voluntary mental health associations (1936-39) recommended the amalgamation of three major mental health organisations: the Central Association for Mental Welfare, the Child Guidance Council, and the National Council for Mental Hygiene. The formal merger had to wait until the end of World War II, but the associations worked together during the war through the Provisional Council for Mental Health. The government asked the Council to provide a national aftercare service for people discharged from military service on psychiatric grounds.

1942    In December, the British Government published the report on Social Insurance and Allied Services. This watershed publication was better known as the Beveridge Report – named after its author, the journalist, academic and Government advisor, William Beveridge, and would shape Government social policy for the rest of the century.

1946   The National Association for Mental Health (NAMH) was formed by the amalgamation of the three major mental health organisations. NAMH lobbied for better services for people with mental health problems, set up day centres and hostels, as well as providing training services for social workers and residential care staff.

1948     The National Assistance Act stated that 'it shall be the duty of every local authority to provide residential accommodation for persons who, by reason of age, illness, disability or any other circumstances are in need of care and attention which is not otherwise available to them'. This, together with the recent introduction of welfare benefits, encouraged the beginning of the move from institutional to community-based care.

1950s     Day hospitals began to be established, increasing flexibility in psychiatric services and reducing the use of hospital beds. Hostels and therapeutic social clubs were set up to provide support for discharged patients. The introduction of neuroleptic drugs helped to shorten the length of new admissions to hospitals and encouraged the discharge of many into the community. Some new district psychiatric services were developed in general hospitals, ceasing to use beds in the regional mental hospitals, providing a model for future changes.

1954     The first out-patient nurses were appointed at Warlingham Park Hospital, Croydon. Their duties included visiting out-patients, supporting in-patients who had been discharged, helping find jobs and accommodation for them, and being available to give advice at out-patient clinics or therapeutic social clubs.

1954     After a steady rise throughout the first half of the century, the resident population of psychiatric hospital beds reached a peak of 152,000. Many of the hospitals were extremely overcrowded; Friern Barnet, for example, was built in 1851 to accommodate 1000 patients and, by 1950, it accommodated over 2,000.

1955    From 1955 onwards, psychiatric in-patient numbers began to slowly decrease due to the introduction of social methods of rehabilitation and resettlement in the community, and the availability of welfare benefits, as well as the introduction of antipsychotic medication.

1957    The Report of the 1954-57 Royal Commission on the Law Relating to Mental Illness and Mental Deficiency (the Percy Report) was published. The report marks the turning point in official policy from hospital-based to community-based systems of care. The Commission recommended that 'the law should be altered so that whenever possible suitable care may be provided for mentally disordered patients with no more restriction of liberty or legal formality than is applied to people who need care because of other types of illness, disability or social difficulty.' The Commission also recommended that 'the majority of mentally ill patients do not need to be admitted to hospital as in-patients. Patients may receive medical treatment from general practitioners or as hospital out-patients and other care from community health and welfare services.'

1959    The Mental Health Act (1959) reinforced the Mental Treatment Act (1930) allowing most psychiatric admissions to occur voluntarily. Following the recommendations of the Percy Report, the procedure for deciding whether a person should be compulsorily detained in hospital changed from a judicial to an administrative process. At the same time, procedures and safeguards around compulsory detention and treatment were tightened.

1960s    It became commonplace for psychiatric nurses to work with patients outside hospitals. Locked doors were beginning to disappear from psychiatric wards.

1961    Enoch Powell, as Health Minister, made his famous 'Water Tower' speech to the Annual Conference of the National Association for Mental Health, later known as Mind. He envisaged that psychiatric hospitals would be phased out and care provided in the community. Powell's plan was for 'nothing less than the elimination of by far the greater part of this country's mental hospitals as they stand today'.

1962     The Hospital Plan for England and Wales stated that large psychiatric hospitals should close and that local authorities should develop community services.
In-patient numbers continued to fall, but many local services were not yet in place. A new group of 'long-stay' patients began to accumulate in the hospitals. The era of community care had begun and this has remained official policy ever since.

1968     The Health Minister, Kenneth Robinson, stated that progress in modernising the organisation of mental health services was lagging behind progress in applying modern methods of treatment. Robinson proposed the Worcester Development Project to demonstrate how the problems of transition from the old psychiatric hospitals to modern community-based mental health services could be identified and solved in a co-operative exercise between local health authorities and local authorities.

1970     The Chronically Sick and Disabled Person's Act required local authorities to find out the needs of people in their local populations and to provide certain services for them. They also had a duty to publicise the fact that these services were available.

1970    The Local Authority Social Services Act created social services departments as we now know them. With effect from 1972, all personal social services were to be brought together in one department.

1972    The National Association for Mental Health changed its name to Mind. The Mind office in Wales was opened (it was renamed Mind Cymru in 1997).

1975      The White Paper 'Better Services for the Mentally Ill' looked at developments since the 1962 Hospital Plan. It set out a blueprint for an integrated local approach to mental health care involving the health service, local authorities and the voluntary sector. The White Paper set out what facilities were required and set numerical targets for achieving better and more appropriate services. 'Better Services for the Mentally Ill' came at a time of recession and pessimism about public services; it had little impact on the haphazard dissolution of the hospitals and the almost total failure of statutory authorities to provide adequate community based care.

1977     The NHS Act was introduced. Section 28a of the Act gave health authorities the power to transfer money to support local authority services. Section 28a was introduced primarily to assist with the re-provision of mental health services from NHS long-stay psychiatric hospitals to newly developed services in the community.

1970s    Debate focussed on reviewing the Mental Health Act (1959). Limited progress was made towards the aims of the 1975 White Paper. Social Security benefits became available to individual claimants for board and lodging charges. Many long-stay patients formerly a charge on the NHS were discharged to the community, where they were to become a charge on local authorities; however the charge was moved to the DSS. The government introduced a small Joint Finance fund to encourage the transfer of services from the NHS to local authorities to foster community-based developments.

1981    The Department of Health published a consultative document entitled 'Care in the Community'.

1982    The Barclay Report was published. This was, in effect, a Government prospectus for the future planning of social work. It recommended that people in need should no longer be seen as isolated individuals, but in terms of their relationships with family, friends, local community etc. The Report stated that social services should be organised on a local patch basis.

1983    The Mental Health Act (1983) provided safeguards for people in hospital. Section 117 of the Act imposed a duty on district health authorities and social services departments (in co-operation with voluntary agencies) to provide after-care services for people discharged from hospital.

1985   The Social Services Select Committee Report 'Community Care with Special Reference to Adult Mentally Ill and Mentally Handicapped People' stated that hospital closures had outrun community care provisions, especially in relation to people with mental health problems. There were calls for Government action and increased spending. In the Committee's own words: 'A decent community-based service for mentally ill or mentally handicapped people cannot be provided at the same overall cost as present services. The proposition that community care should be cost neutral is untenable….Any fool can close a long-stay hospital: it takes more time and trouble to do it properly and compassionately.'

1986    Despite the halving of the psychiatric hospital population between the mid-1950s and the mid-1980s, it was 1986 before the first psychiatric hospital was fully closed down. The late 1980s and early 1990s would mark the closure of many of the large old hospitals.

1986   The Report of the Audit Commission for Local Authorities in England and Wales, 'Making a Reality of Community Care', pointed out that despite the reduction in hospital beds, local authorities had not been allocated the resources necessary to provide alternative forms of care. Sir Roy Griffiths was given responsibility for reporting on this.

1986    The Disabled Persons (Services, Consultation and Representation) Act was brought in to strengthen the legislation laid down in the Chronically Sick and Disabled Person's Act. Section 4 of the Act gave local authorities the duty to assess people for services if asked to do so by the individual, their representative or carer.

1988    The Griffiths Report was published. Its recommendations included the appointment of a Minister of State for Community Care and the transfer of all community care to local authorities. The Report recommended giving 'earmarked' grants, partly funded by central government, to local authorities. It also recommended that local authorities be allowed to purchase services from other agencies.

1989    The launch of the 1989 All Wales Mental Illness Strategy (Welsh Office 1989) provided an impetus to develop mental health services in Wales. Community orientated and locally based services were developed to include the establishment of multidisciplinary community mental health teams (CMHTs) throughout Wales.
A wealth of voluntary sector facilities have since been developed including drop-in facilities, self help groups and employment training. These changes enabled some of the large older institutions to be closed, including North Wales, Parc, Mid-Wales and Pen-y-fal hospitals.

1990    The NHS and Community Care Act (1990) made all the legal changes necessary for the implementation of 'Caring for People'. Local authorities, in collaboration with health service and independent sector agencies, now became responsible for assessing need, designing care packages, and ensuring their delivery.

1991    The Mental Health Specific Grant was introduced for mental health services in the community. This grant could only be spent with the joint agreement of local health authorities and social services departments. It was designed to encourage authorities to plan together so that a broad spectrum of services would be developed.

1991   Local Authorities were made responsible, under the NHS and Community Care Act, for the registration and inspection of homes and other community services either purchased or provided by them.

1991    The Care Programme Approach (CPA) was introduced in an attempt to improve and standardise the delivery of community care services. The CPA set out a practice framework for Health Authorities in England, giving guidance on how they should fulfil their duties as laid out in the NHS and Community Care Act 1990. The CPA relied upon liaison between health and social care agencies to ensure that people with mental health problems received appropriate levels of support in the community.

1992    Report of the All Wales Advisory Group on Forensic Psychiatry.

1992     Under the NHS and Community Care Act, local authorities were expected to publish Community Care Plans outlining the development of community-based services. They were also expected to show that they were making the best possible use of the independent sector.

1993    Local authorities were given the responsibility for making Community Care Assessments. However, the NHS and Community Care Act stated that health authorities would retain their responsibility for providing long-term healthcare for those in need.

1993    The Secretary of State for Health issued 'Guidance on the Introduction of Supervision Registers' . People considered to be 'at risk of harming themselves or other people' could be placed on a supervision register, aimed at ensuring they remain in contact with mental health services and that their care was monitored on a regular basis, embracing the principles of the Care Programme Approach.

1994    The Department of Health set out its 'Framework for Local Community Care Charters in England'. The framework stated that local authorities should consult users and carers, voluntary organisations, independent service providers and others to ensure that their charters reflected local priorities and concerns.

The charters would give service users and those involved in providing their care better opportunities to influence service delivery. Charters would give people clear information about what they could expect from local authorities and would give local authorities the criteria, against which they could measure and improve their services.

1995    The Mental Health (Patients in the Community) Bill proposed new powers regarding the after-care of people discharged from hospital. Under this Bill, some service-users could be required to live at a specified address and to attend certain places for treatment, occupation, education or training. The after-care arrangements for each individual would be kept under review. A 'supervisor' could convey the service-user to a place where they were to receive aftercare, but they could not force the person to have treatment against his or her will. The 'supervisor' could also authorise another person to use the power to 'take and convey' the service-user. There was no requirement placed upon Health Authorities and Trusts in Wales to establish and maintain Supervision Registers.

1996    The Welsh Office published 'Guidance on the Care of People in the Community with a Mental Illness'. The guidance addressed:

• the continuing role of the community mental health team (CMHT) within the specialist mental health services

• the provision of care and support including the assessment process, management of risk, discharge and aftercare arrangements

• the use and disclosure of patient information and immediate arrangements for improving communication and continuity of care across agencies.

1996    The Mental Health (Patients in the Community) Act of 1995 became law. The Act worked by adding section 25 to the Mental Act 1983 that contained the new powers. [See Mental Health (Patients in the Community) Bill above].

1996    The Carers (Recognition and Services) Act amended the NHS and Community Care Act (1990). It placed a duty on local authorities to carry out an assessment of the needs of carers for services such as respite care.

1996    Community Care (Direct Payments) Act 1996 gave local authority social services departments power to make direct cash payments to some individuals in lieu of the community care services they had been assessed as needing, to enable them to secure for themselves the relevant services.

1998    Community care was declared a failure. Health Secretary, Frank Dobson, stated that 'Care in the community has failed. Discharging people from institutions has brought benefits to some. But it has left many vulnerable patients to try and cope on their own. Others have been left to become a danger to themselves and a nuisance to others. A small but significant minority have become a danger to the public as well as themselves.' Mind, along with many others, disagreed with the statement that community care had been a failure.

1999    The Government published a National Service Framework for Mental Health (NSF) for England. The NSF spelled out national standards for mental health services, what they aimed to achieve, how they should be developed and delivered, and how performance would be measured in every part of the country.

1999    The Home Office and Department of Health produced a consultation paper on 'Managing Dangerous People With Severe Personality Disorder'. The paper announced plans to introduce a new legal power of 'indeterminate but review-able detention of dangerous personality-disordered individuals' who present a grave risk to the public (for previous offenders and non-offenders).

1999    The Government published proposals on reform of the Mental Health Act in England and Wales. Before publishing these proposals the Government received a report from an Expert committee, chaired by Genevra Richardson, which had spent 10 months reviewing the Act. Unfortunately, many of the more positive aspects of the Richardson report were not accepted by the Government. Mind warned the Government that plans to introduce compulsory treatment in the community would 'backfire' and drive users away from services.

1999    The National Institute for Clinical Excellence (NICE) was set up as a Special Health Authority for England and Wales on 1 April. Part of the NHS, its role is to provide patients, health professionals and the public with authoritative guidance on current 'best practice'. The guidance covers both individual health technologies (including medicines, medical devices, diagnostic techniques, and procedures) and the clinical management of specific conditions. NICE guidelines relating to mental health issues include:

• atypical antipsychotics for schizophrenia (June 2002)

• eating disorders (December 2003)

• bipolar disorder - new drugs (July 2003)

• depression (January 2004)

• self-harm (February 2004)

• anxiety and related problems (May 2004)

More information is available at www.nice.org.uk

1999    Section 31 of the 1999 Health Act outlined new powers to enable health and local authority partners to work together more effectively which would come into force on 1 April 2000. This included pooled funding and integrated provision.

2000    Direct payments were extended to those aged 65 and over. 'An Easy Guide to Direct Payments' was published in April 2000 to promote direct payments for people with a learning disability. The Government expressed a wish that people who currently had Preserved Rights to Income Support for long term care costs should also be offered direct payments if they wanted to leave residential care.

2000    The National Assembly for Wales published its draft Adult Mental Health Services Strategy for Wales, entitled 'Equity, Empowerment, Effectiveness, Efficiency'.

The final strategy from the consultation process will provide the strategic background against which a National Service Framework for Wales (NSFW) for adult mental health services will be developed. The draft Strategy states that: 'It is right.. that a National Service Framework for Wales (NSFW) should differ in some important respects from the English document as there are distinctive differences in emphasis that reflect particular circumstances in Wales. The standards set should be at least as good as those set for England.'

2000    The draft Child and Adolescent Mental Health Services Strategy 'Everybody's Business' was published in June.

2000    The Mental Health Alliance, a group of over 50 major voluntary organisations, service-user groups, service-providers, professional organisations and trade unions lobbied parliament to press for changes to the Government's plans for a new Mental Health Act. The Alliance wants a new Mental Health Act that will:

• include a legal right to care and treatment
• result in the reduced use of compulsory powers.
  

2000    Home Affairs Select Committee's report published on Managing Dangerous People with Severe Personality Disorder.

2000    The NHS Plan set out plans for increased funding, and for reform of many sections of the NHS. This included the establishment of a National Care Standards Commission. The NHS Plan promised hundreds of mental health teams to provide an immediate response to crises.

2000    The National Director of Mental Health (widely known as the 'mental health czar') was appointed. The postholder, Professor Louis Appleby, said that key areas of the National Service Framework would include:

• the phasing out of mixed sex psychiatric accommodation over the next two years

• the elimination of out of area acute admissions as soon as possible

• 24 hour access to mental health services for patients and carers in place by April 2001

• website set up for patients/users, families/carers and staff to give their views directly to Professor Appleby

• new training and courses for psychiatrists in 'cultural awareness'

• a drive to encourage more nurse consultants in the mental health area, particularly to work with people with mental ill-health and drug and alcohol problems.

More information at: www.doh.gov.uk/mentalhealthczar

2000    The Care Standards Act set up National Care Standards Commission for England.

2001    National Care Standards Commission was set up in April, and began regulating services in April 2002. It took on the four main roles suggested by the Royal Commission on Long Term Care:

• monitoring

• representing the consumer

• providing national benchmarks

• encouraging the development of better services.

It establishes a General Social Care Council for England and a Care Council for Wales to regulate social care workers (abolishing the training body CCETSW), and sets up a new protection of vulnerable adults list to ensure unsuitable people are prevented from working with vulnerable adults.

2001    National Assembly for Wales launched the Adult Mental Health Services Strategy

The Adult Mental Health Strategy includes four key principles:

• equity: mental health services should be available to all and allocated according to need

• empowerment: users and their carers to be integrally involved in planning, development and delivery of mental health services

• effectiveness: mental health services should provide effective interventions that improve quality of life

• efficiency: mental health services must use resources efficiently and be accountable for the way public money is spent.

2001    Child and Adolescent Mental Health Services Strategy for Wales was introduced.

The main points are:

• services must be child-centred

• good inter-agency working essential

• a needs assessment for Wales is essential

• role of voluntary sector must be strengthened.

2001    Health and Social Care Act introduced a number of measures to modernise the regulation of Family Health Services (FHS) in relation to all four FHS contractor professions: medical, pharmaceutical, optical and dental.

2001    At Mind's annual conference in Scarborough in November, the Health Minister, Jacqui Smith, announced funding ring-fenced for mental health, aimed to improve a range of community mental health services including assertive outreach teams, early intervention for young people, crisis resolution teams, and help for people in prisons.

2001    NHS (Wales) Bill was published. Its proposals include consulting health service users in developing services, establishing an Association of Welsh Community Health Councils, the development of the Wales Centre for Health as an independent training, advisory and research body designed to facilitate partnerships with the Welsh Assembly, the public, voluntary and academic sectors.

The Bill also addresses issues relating to training of professions supplementary to medicine.

2001/2    The Social Care Institute for Excellence (SCIE) was established by the Department of Health and the National Assembly for Wales as part of the Government's Quality Strategy for Social Care. It began work in October 2001, prior to its formal launch in spring 2002. SCIE works closely with Government, with the new regulatory bodies, the General Social Care Council and the National Care Standards Commission, and with other social care organisations, practitioners and users. Partnership and commissioning will be key features of the new organisation. More information at: www.scie.org.uk

2001-2002     The Supporting People programme was set up, offering vulnerable people the opportunity to improve their quality of life by providing a stable environment that enables greater independence. It will deliver high quality and strategically planned housing-related services that are cost effective and reliable, and complement existing care services. The planning and development of services will be needs led. Supporting People is a working partnership of local government, service users and support agencies. More information at: www.spkweb.org.uk

2002     The National Service Framework For Mental Health (Wales) was developed following the publication of the Adult Mental Health Strategy for Wales. The NSF aims to set standards for services in Wales, drive up quality and reduce unacceptable variations in health and social services provision. It establishes the practical guidelines to ensure consistent and comprehensive implementation of the Strategy's vision across Wales. More information at: www.wales.nhs.uk/nsf

2002     'Fairer Charging Policies for Home Care and other non-residential Social Services' practice guidelines published. More information at www.doh.gov.uk/scg/homecarecharges

2002     National Service Framework for Older People published, setting new national standards of care for all older people, whether they live at home, in residential care or are being cared for in hospital. Its aim - backed by £1.4 billion extra to be invested every year by 2004 - is better health and social care services for older people. More information at www.doh.gov.uk/nsf/olderpeople.htm

2002     Consultation document 'Women's Mental Health: Into the Mainstream', published. More information at www.doh.gov.uk/mentalhealth/women.htm

2002     Draft Mental Health Bill published, and opposed by the Mental Health Alliance, a coalition of over 50 organisations who share common concerns about the Government's proposals to reform the Mental Health Act (1983). Although this legislation was not mentioned in the Queen's Speech in November 2002, the Government said it was still proposing to introduce it in this session.

More information at www.doh.gov.uk/mentalhealth/draftbill2002/index.htm