‘Community care’ is a term that has become a short hand for a range of policies. These policies have been introduced in a range of areas – adult and older people's services and services for people with learning disabilities. The term is most closely associated with the mental health field. It came to be a pejorative one that was most closely associated with the failings in mental health services in the late 1980s and early 1990s (Cummins, 2013). One of the key themes of this book is that any analysis of the current crisis in mental health services has to take account of the events of that period and the policy responses to it. Community care and its history is a key factor in the current position of mental health services. In tracing the history of community care, this chapter will explore the ways in which the progressive idealism that challenged coercive institutionalised forms of psychiatry has been replaced by a more bureaucratic dominated mode of mental health service. The original critics of institutional psychiatry, such as Laing, Foucault and Goffman, are a diverse group of thinkers. What they share is a concern with the way that psychiatry was a form of social control and an exercise in power. The chapter will argue that the impact of the failure of community care to live up to its original ideals is part of the reason for the continued focus on risk and risk management that are key elements of modern mental health practice.

The case for community care

On one level, it seems rather odd to have to make out the case for community based mental health services. Surely, the asylum regime has become so discredited. However, it is important to remember that the asylums were not always the institutions that they became or have become in the popular imagination. In addition, making the case or exploring the roots of community care can act as a counter to a backlash which has seen some argue for the return of the asylum. I have argued that community care is a progressive notion that was poorly implemented (Cummins, 2017b). It would be a mistake to assume that progressive values were the only factor.