Community care

Community care for people with mental health difficulties far precedes the formation of the NHS. Through the middle ages, communities cared for their own, with the terms ‘village idiot’ and ‘lunatic’ being attributed to people with mental impairment. As far back as the 12th century monks known as ‘soul friends’ took perhaps the earliest description of a mental health nursing role in the community. The monks would visit people who were suffering from mental disorders and offer them (and their families) spiritual guidance.

During the 1600s and 1700s, people who had no means of sustaining themselves in the community were accommodated in ‘madhouses’. People attending were concerned with keeping order rather than taking a caring role.

It was not until the 18th century when physicians such as William Battie and Thomas Withers recognised that these roles were essential to the care of people. They advocated that staff be specially selected and trained, and saw their role to be what we now know as therapeutic, to keep people occupied, to engage in conversation and offer companionship (Nolan, 1993).