Introduction

Best Practices in Reforming Mental Health Services has just been launched by Health & Welfare Canada, the Federal Ministry of Health (Health & Welfare Canada, 1997). Since the beginning of the 1990s, many of the ten provincial governments, all responsible for the planning, financing and governance of health and social services, have produced new mental health policies, with particular regard to severely mentally ill patients. Indeed, as with many industrialised countries, Canadian planners consider that we have entered an era of transformation for services in need of a reform. These documents talk about moving and ensuring proper care in the community and indicate the main service components at the patient, local and provincial levels.

But are we witnessing a social reform? Can it not be argued that this is just another phase in the pursuit of further deinstitutionalisation and development of community care? The deinstitutionalisation and community care movement started three to four decades ago. Consider how in most industrialised countries there has been a steady decline of psychiatric hospitals’ population (but no country has done without these facilities), the development of general hospital psychiatric services, of ambulatory outpatient and rehabilitation services. The movement has been fuelled,as indicated in Chapter 2, by social forces: humanitarian, clinical and economic (see also Lesage & Tansella, 1993). Humanitarian concerns have fostered the view that people with disabilities, physical or mental, shall not be segregated and shall live as normal a life as possible in their community.