Mental health services have been in a process of transformation in England since the start of the 21st century. The main aim of this chapter is to highlight the development and content of current community care policies in English adult mental health. The chapter focuses on the building blocks of government policy and guidance for mental health services. We shall present a brief overview of the recent policy and legal changes that constitute milestones in the development of community (and hospital) care (Table 6.1).

The NHS and Community Care Act 1990

This 1990 Act was the culmination of a series of reports, as indicated in Table 6.1. One of these was the 1985 authoritative review of community care provisions produced by the House of Commons Social Services Select Committee, under the chairmanship of Renée Short (hence it was called the ‘Short report’); it made 101 recommendations, and concluded with the message that community care ‘cannot be and should not be done on the cheap’. The NHS and Community Care Act aimed to bring greater coordination to the provision of community care by the health and social services. The Act required local social services and health authorities to jointly agree community care plans which clearly indicated the local implementation of needs-based, individual care plans for long-term, severely ill and vulnerable psychiatric patients. The key objectives of the Community Care Act are listed in Box 6.1.

A key role defined in the Act was that of the care manager. ‘Care management’ needs a special word of clarification. The term was introduced in 1991 as a variation of the term ‘case manager’, which had been used for the previous decade in the USA. ‘Care manager’ described the role of qualified social workers who assessed the needs of service users and who then purchased care services from other providers. It was different from the role of Health Service ‘key workers’, who assessed needs and then also provided care.