This chapter describes the development of social concepts within psychiatry and the mental services between 1960 and 2010. This occurred against the backdrop of the emergence of new social theories concerned with psychiatry, medicine, science and other institutions of liberal democracy from the very beginning of the period. Attacks on the legitimacy of psychiatry came from postmodernists on the left and neoliberals on the right and coincided with a distancing between psychiatry and sociology. Organised psychiatry reacted defensively to most, but not all, of its critics and had difficulty assimilating even those new social theories that appeared neutral with regard to the professional and scientific status of psychiatrists. In the last decade of the period, empirical evidence regarding social determinants of mental health, together with the failure of biomedical technology to deliver on promises of better treatments, led to the beginnings of a revival of interest in social factors within academic psychiatry.

The era saw the gradual closure of the mental hospitals and the development of care in the community – a process known as ‘deinstitutionalisation’. Community care revealed its own problems: some patients were merely transferred to different kinds of institution; lack of funding; and the unease of some psychiatrists in working outside the hospital. There was the innovative development of multidisciplinary teams; sectorisation; and district general hospitals (DGHs). The Royal College of Psychiatrists was founded in 1971, leading to formal education schemes for trainees and the creation of psychiatric specialties. The psychiatric profession underwent a crisis of confidence as a result of several factors: the increasing privatisation of the health service; the challenge to its authority from both other mental health professionals and the emerging service user movement; and problems with recruitment.