The 1959 Mental Health Act represented, by any standard, a ‘paradigm shift’ in the way in which mental illness was construed, not just in Britain but anywhere.

Robairt Clough was a long-term patient at Holywell Psychiatric Hospital in Antrim (Northern Ireland). In the Christmas 1972 edition of the patients’ magazine, he wrote the following verses

The size of the field in which psychiatry claims expertise has expanded dramatically since the nineteenth century when alienists only dealt with madness (renamed psychosis after the 1860s), epilepsy and some organic disorders. Social history possesses methodologies apt for the exploration both of the world of concepts and values and of the dark forest of economic interests. This book may be pointing to another useful way of doing history of psychiatry. Its findings should add to the periodic documentation required by British psychiatry. There is a need to explore how values and economic interests affect neuroscientific research as well.

There remains a gap between needs, aspirations and delivery in psychiatry and mental health. To close this gap there is a need to attend more intensely to social science and mad studies, as well as neuroscience, in professional formation in psychiatry and mental health. Further strengthening of the nursing profession and greater engagement of action therapies will also help close the gap in practice. To be effective, such efforts must be underpinned by a commitment to pluralism.

This chapter will review the societal and political context in which there was an evolution of approaches to address the mental health needs of children and young people.

I go about my domestic duties in mourning, sighing over the melancholy void that death has made … There sits her empty cradle … I shall never see her sleeping there again.1

The period 1960–2010 has been one of marked change in UK society and mental health services. Prominent changes have included deinstitutionalisation and community care in mental health. These have taken place in an evolving framework of liberalisation, marketisation and globalisation. The global financial crisis of 2008 and the increasing impact of information technology, social media and artificial intelligence have ushered in a new era of meta-community care, which is now affected by the shock of Covid-19. It is timely to look back over the half-century of 1960-2010 to study and learn the lessons from developments in mental health during what has been labelled the neoliberal era, now in retreat.

This chapter opens with a summary of advice on interviewing people with intellectual disabilities. Then the need rating algorithm is provided, as it applies to CANDID-S and Section 1 of CANDID-R. Need ratings of met (M), unmet (U) and no need (N) represent a change from the numerical ratings of CANDID 1st edition. Furthermore, a set of frequently asked questions and comprehensive answers is provided. The questions are applicable to both CANDID-S and CANDID-R.

A comprehensive training programme for completing the CANDID is described. It covers both versions of CANDID and provides all training slides and notes for the trainer. Learning points covered are the background to the CAN approach, the policy background to needs assessment in intellectual disabilities services, the concept of need, research using CANDID thus far, CANDID domains, need rating (no need, met need, unmet need), CANDID rating algorithm, structure of the CANDID (including trigger questions, anchor points, perceptions of help of interventions, and the differences between staff, service user and informal carers assessment of needs. Two case vignettes are provided along with expected ratings. A role play is suggested in order to give participants the opportunity to learn, practice or consolidate needs assessment using CANDID. A discussion focusses on the rationale behind each rating,

The development and psychometric evaluation of the CANDID is reported. It was developed by modification of the Camberwell Assessment of Need (CAN). The four principles that informed the development of the CAN and the CANDID are 1. people with intellectual disabilities and mental health problems have basic needs like everybody else along with specific needs associated with their conditions 2. the primary aim is to identify rather than describe in detail each need; once a need is identified more specialist assessment can be conducted in those domains 3. needs assessment should be possible to be conducted by a wide range of people, so that it can be applied in routine clinical practice 4. there may be differences of opinion about the existence of need amongst people involved and therefore different points of view should be recorded separately. The reliability and validity of CAN have been investigated and found to be acceptable. Research studies using CANDID are summarised here.