This volume has examined the impacts of deinstitutionalisation and community care. These are two aspect of the shift in mental health policy in the past 60 years. I argue that these need to be analysed but are fundamentally connected. The asylum and the community were often presented in a rather limited and concrete fashion as polar opposites of each other. The failings of the asylum regime would disappear in community settings. If there is one lesson from the deinstitutionalisation process it is that all the failings and abuses of the asylum regime have appeared in one modified form or another in community settings. This is most dramatically apparent in the various inquiries and reports that appear in this volume. The Gauteng scandal is the most extreme example of this. However, we witness other examples – such as homeless individuals who are clearly experiencing some form of mental distress – on a daily basis. This raises a more fundamental question about investment in mental health services and the social state more generally.

There are two clear strands to the development of deinstitutionalisation: fiscal conservatism, concerned with the cost of all state welfare provision, including mental health services; and a civil rights approach to the treatment of the mentally ill. By the 1980s, the long-stay mental hospitals were no longer sustainable. This was because of an acceptance that the care they provided was, overall, inadequate. In the UK, the Thatcher government, when it introduced the NHS and Community Care Act (1990), was clear that the economic policies of the government meant that new funding arrangements were demanded. The optimistic view that the abuses of the institutions would be replaced by mental health services founded on civic notions did not survive in the harsh political and economic climate of that period. The government and wider policy responses focused on organisational and audit issues.

In his discussion of Foucault's lectures that were published as The Birth of the Biopolitics, Garrett (2018) notes that neoliberalism is now a contested term.