Social factors and Recovery: Out of the asylum but still a long way to go

Abstract: Mental health interventions matter most where they result in improvements in the social lives of patients. Those resettled from the asylum preferred living in the community and experienced few adverse outcomes. Resettlement was undoubtedly institutional in nature, patients having little or no choice over where, when or with whom they moved. The underlying ‘train then place’ rehabilitation model persists to this day, with step-down towards independence contingent on the (re-)acquisition of daily living skills. Subsequent recognition of the importance of choice and person-centred care has led to interesting questions about this model. Emerging evidence suggests instead a ‘place then train’ approach, involving a rapid move to independent accommodation or to open job placement with support following as necessary. The relationship between service user and the professional providing care is critical for these optimistic person-centred interventions. It is therefore disquieting to observe declining continuity of care and care models that promote fragmentation of the care team.