This paper reports and reflects upon 50 years’ evolution of social psychiatry in the UK context, including internal debates, and parallel policy and service developments in the “outside”, nonhealth world. It reviews the history and development of the therapeutic community approach since the immediate post-war era, summarises the current position in emerging UK policy, and looks to the future with new conceptual tools to describe current initiatives in public mental health and community-oriented mental health.

A review and analysis of historical, research and “grey” literature (ie: especially government policy pronouncements), including discussions with clinicians and policy makers over future trends.

Two new conceptual frameworks are emerging - the “Psychologically Informed Planned Environment” and the “Enabling Environment” - which between them both embody and encourage current new thinking on the health and well-being contexts of community cohesion, and the introduction of enlightened management for enhanced well-being in hospitals, prisons, schools and workplaces, housing projects and places of faith.

From the remnants of the post-war therapeutic community movement, a new terminology is emerging to address the demands of community psychiatry for the 21st Century. Recognising the social determinants of health and the challenge to health inequalities, and the health and well-being contexts of social capital and community cohesion, this framework raises quasi-philosophical questions over shared values, and highlights the necessity to work with reflective practice and collective accountability for an inter-dependent world.