Historical applications of the Goldberg and Huxley Pathway to Psychiatric Care Model

The Pathway to Psychiatric care Model was published by David Goldberg and Peter Huxley in 1980, based on practice within the British NHS from 1948, and on epidemiological data mostly from Europe and the USA. The ‘filters’ in the model were derived from assumptions about practice, and levels of care, at that period. This paper explores the implications of applying the model historically to patterns of English psychiatric care firstly from 1834/1845 to 1959, with parallel public, philanthropic and private systems of healthcare; and secondly to patterns of care after c.2000. The model is a powerful conceptual tool for understanding how mental health systems function, and the central importance of referral and transition decisions. This analysis points to the influence of changing ‘regulatory cultures’, at one remove from the immediate clinical encounter, and to the implications of a much wider range of mental health practitioners than in 1980