With mental illness on the increase and a constant feed of news stories announcing cuts and blunders in services, we could be forgiven for concluding that Care in the Community hasn't worked. This is a simplistic conclusion to a complicated issue.

Over the past 30 years we have moved away from housing patients in Victorian-era asylums for years. We now focus on early intervention and prevention, with the emphasis on keeping and treating people in the community. This shift is not based on woolly liberal thinking. It is based on providing effective clinical carefor people with mental health problems. That's one in four of us - you, me or someone we know.

A good example is the specialist teams that support people at home who would otherwise have had to be admitted to or stay longer in hospital. These services are both popular with people who use them and effective in keeping people out of hospital.

Intervening early, before people get to crisis point, is proven to be effective, for example, for young people who develop symptoms of psychosis. At South London and Maudsley NHS Foundation Trust we conducted a randomised control trial on early intervention - the first of its kind in the UK, and one of a few world-wide - based on people using services in Lambeth. We found that, 18 months after developing the first signs of psychosis, people supported by the early onset service had regained or established more social relationships, spent more time in employment or education and reported a higher quality of life. They were also less likely to relapse.

We need to continue to provide people with effective alternatives to hospital treatment. By doing so, the focus of service provision remains where it should be - on trying to prevent people from reaching the point of crisis where the only option is admission to hospital. There is an unfortunate tendency to blame Care in the Community on the rare occasions when someone with a serious mental illness commits homicide or (much more frequently) takes their own life. Such events are tragic, and everything should be done to prevent them. But in my view, simply returning to large asylums or opening large numbers of new beds is not the answer.

Dr Martin Baggaley,
Medical director,
South London and Maudsley NHS Foundation Trust

Published in Times (Public Agenda), 4 September 2007