Tom Bromwich
General Manager
From the Poor Law to
New Horizons
History of Mental Health Care in England
1601 Poor Law
Introduced a clear responsibility for every Parish
to support those who were incapable of looking
after themselves.
Perhaps an early root for the association of
poverty and disability.
Further legislation in 1834 led to the building
of the Workhouses
1845 The Lunacy Act
This act required Counties to provide asylums
this lead in the following years to the building of
the majority of Britain’s psychiatric hospitals.
The growth was fuelled by funding
arrangements which encouraged Parishes to
move people into Asylums.
Thus the large psychiatric institutions were
First central government funding for health or
social care was introduced with subsidy of
“pauper lunatics” in asylums.
1926 Royal Commission on
Lunacy and Mental Disorder
Suggested that out patient clinics be developed,
concept of voluntary admission to psychiatric
hospital and concept of prevention and
treatment rather than detention was introduced.
1930 Amendments to Poor Law
Terms such as Pauper Lunatic were abolished
and 1930s generally sees development of out
patient and social work provision.
1948 National Assistance Act
Introduced a duty on local authorities to provide
residential accommodation for persons who due
to age, illness or disability where this was not
otherwise available to them. This begins a
move towards community based care.
1954 Peak of inpatients in
Psychiatric Hospitals
1962 Hospital Plan
for England and Wales
Stated that large psychiatric institutions should
close and local authorities should develop
community services.
First large psychiatric hospital closes but it was
only by the early 1990’s that majority of larger
institutions had closed.
1995 Disability Discrimination Act
The Act made discrimination against people due
to their disability illegal and required employers
to make reasonable adjustments in work place.
There are some weaknesses in the act relating
to mental illness.
DDA is amended in 2005 to remove the
emphasis on clinically well defined
mental illness.
1998 Health Secretary states
“care in the community has failed………many
vulnerable patients left to cope on their own”
Not all agreed that the policy had failed but
evidence suggested that closure of institutions
and re assimilation of people into society had
been poorly planned and executed.
1999 National
Service Framework
National standards for mental health services
are defined.
2004 Mental
Health and Social Inclusion
This document underlines the importance of
work and its role in social inclusion.
Direction of travel away from investment in day
services and into supporting people to return to
2006 Layard Report
Report on depression and anxiety which
recommends the use of psychological therapies
on economic grounds.
This is now the NHS Increasing Access to
Psychological Therapies programme available
through self referral or through General
2008 ESA & Pathways to Work
The Government introduced changes in Incapacity Benefit [a
passive benefit for people with disabilities] into Employment
Support Allowance [ESA] which requires some people who may
be able to work with the appropriate support to engage on
mandatory work focussed activity.
The package of support introduced is the Pathways to Work
The Government have had in place for a number of
years a programme called Workstep which
supported people to return to work but on
a voluntary basis.
2010 New Horizons
New Horizons is a policy document which sets out
strategies for the Mental Wellbeing of our population.
It starts with education of children in our schools around
mental wellbeing, strategies for healthy work places,
support for people with mental health issues in gaining
and sustaining work.
But………….new government has put aside this policy
and we await their policy views,
Recovery Movement
Recovery practice assumes that irrespective of continuing
mental health issues people can have purposeful and
fulfilling lives but this depends upon a different
relationship between those experiencing psychological
distress and those providing medical, social and
employment support.
A change from power and control to
co production.
Recovery Movement cont.
The recovery approach is based on three key principles hope, control, and opportunities - and that successful
implementation demands a radical change in staff
attitudes to mental illness and to those experiencing it.
Health and social care provision [NHS] in
Devon are at the fore front of recovery thinking.
Employment is a core aspect of recovery.
Please see