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The evolution of psychiatric care — a spiral model

Maudsley Hospital, Denmark Hill, London SE5 8AZ

Raveen Hanwella, Registrar

Department of Psychiatry, The Warneford Hospital, Headington, Oxford OX3 7SX

^* Correspondence

The present trend towards community care with the continuing closure of the old Victorian institutions has given rise to much argument for and against community care. Incidents of violence by mentally ill patients against members of the public have resulted in some backlash against community care. There are fears of a return to the days of the institution. It is proposed that these changes can be predicted from a model that we have called the ‘spiral model’. An understanding of this model might help to prevent history from repeating itself.