There has been a curious linguistic shift in the use of the word community in mental health (Holmes, 2001a). In the 1950s and early 1960s community psychiatry was synonymous with milieu therapy and the therapeutic community – that is, the attempt to create a vibrant community of patients and staff, in a shared space, working actively together to overcome disability, illness and stigma. The contrast was with insitutional psychiatry, caricatured as the silent, soulless and, at times, abusive wards of the Victorian mental hospital. The therapeutic community had two main psychotherapeutic tools: group therapy and creative therapies such as art therapy and psychodrama. These approaches were pioneered in specialist units such as the Henderson hospital (Norton & Haigh, 2002) but, more generally, progressive acute units emphasised the use of ward groups and the importance of patients playing an active part in decision-making.