Two steps forward, one step back

This paper reviews the last 30 years of developments in UK psychiatry and looks forward at what possibilities exists for the specialty in the years to come. At the beginning of the era there was a short interlude when progressive innovations became easier, as the unintended consequence of NHS ‘reforms’. The subsequent period has been dominated by efforts to control professional conduct, with the effect that there has been an increasing emphasis on services’ use of compulsion and duress. The focus of services has moved away from care of the chronically ill and towards time-limited intervention. I see little possibility that this emphasis on ‘safety’ will diminish, nor that the commodification of publicly funded services is likely to diminish. I anticipate that there will be an increasingly two-tier service, with the neglect of people who are chronically ill. However, new interest in social psychiatry, a less insular clinical psychology, a renewed emphasis on relational psychiatry, the service user movement and the global psychiatry movement are all reasons for optimism. Although the community psychiatry ideal seems dead in the public sector, these ideas may flourish outside of it.