Introduction

Major changes in the medical care of people suffering from schizophrenia have taken place in the last 30 to 40 years. With the advent of the major tranquillisers in the 1950s, psychiatrists were able for the first time to treat the severe symptoms of hallucinations and delusions, which meant that patients who would formerly have remained in hospital long term could be discharged (Brown, Murray-Parkes & Wing, 1961). This improvement in treatment, combined with the recognition that institutional life in itself seemed to exacerbate the lack of motivation and social withdrawal of many long-stay patients (Wing & Brown, 1970), has contributed to a fall of over 100 000 in the psychiatric hospital inpatient population in England from its peak of 150000 in the mid-1950s.

Since the mid-1970s UK government policy has been to continue to discharge patients from the old large mental hospitals and eventually to close them altogether, replacing them with a network of health and social services in each district, including general hospital psychiatric units, day hospitals, community psychiatric services and local authority residential, day care and social support services (Department of Health and Social Security, 1975).

Since the shift from hospital care into the community, most people suffering from schizophrenia now spend nearly all their lives outside hospital. This presents a challenge to general practitioners.