Policy for mental health services in England is based on two straightforward principles. These are first, that care should be provided as locally to where a person lives as is reasonably possible, and secondly, that treatment should be available in the least restrictive conditions that are compatible with the safety of the patient, of those looking after him and of the public at large. In considering the practical application of these principles, I make no apology for reviewing the history of policy and practice; it is not possible, in my view, to understand the mental health services we are trying to achieve for the future without understanding how the service has developed over the years. I do so, against a background of the radical changes that have occurred in the provision of services for mentally ill and mentally impaired patients generally, in criminal justice legislation and in the judicial process; and, perhaps most importantly, in public perceptions and attitudes. An evaluation of the extent of the implications of these developments, and the impact that they have had specifically on the nation's response to the needs of the mentally disordered offender is, I would suggest, at the heart of our business here today.

When examining a service it is easy to sound over-critical. We must not forget that, in general, hospital services for mentally disordered people have improved out of all recognition in the last 30 years. You only have to read the review of developments published by the Hospital Advisory Service in 1985 to see the fundamental changes for the better that have taken place. Rereading the reports of 1969 about Ely Hospital and 1972 about Whittingham Hospital shows how services have improved (HMSO, 1969, 1972). Even the time that I have been in psychiatry has seen the disappearance of wards of 40 people, heated by a single coal fire in winter. In those days, outbreaks of paratyphoid were common and death frequent. The reports to the Board of Control up to 1959, when I first worked in general psychiatry, speak of severe staff shortages - nurses and doctors were almost impossible to recruit. In 1949, there were 405 consultant psychiatrists. In 1987, there were 1924 and some 3500 other medical staff. In 1961, there were six consultants in the special hospitals; in 1986 there were 33. Out-patient clinics were a novelty in 1959.