The promises of the 1980’s painted a very attractive image of mental health care in the early 21st century. The paradigms of community care, of shifting tasks of mental health care to primary and general health care, of technology in the service of people, of the dispersion of stigma of mental illness and of effective rehabilitation supported by new methods of treatment seemed to be sufficiently robust to carry mental health programmes to new heights, to ensure the promotion of mental health and to improve the life of people with mental illness and their families to an unprecedented level.

Now, in the second decade of the 21st Century we can see that some of the paradigms on which mental health programmes were to be built are obsolescent and that the promised state of affairs as far as mental health is concerned has moved still further into the future. The presentation will examine the currently held paradigms of mental health programmes and of psychiatry and draw attention to areas of possible improvements in their formulation.