From Institutions to Care in the Community: The History of Neglect

Abstract

This chapter discusses the historical development of social care and health provision for elderly people and for people with physical impairments, learning difficulties and mental health problems. The response to the perceived needs of all these groups was overwhelmingly institutional in the nineteenth century and early twentieth century. Current services for these groups carry this institutional legacy, and present community care policies are, at least in part, an attempt to shake off that legacy. Thus the inclusion of this chapter is based on the strong belief that a knowledge and understanding of community care history is of practical value to busy social care managers, field-level staff and students as well as of interest to the community care academic. Those struggling with contemporary policy issues can be supported through a grasp of the way the current situation came about. Undertaking contemporary social history certainly has its own intellectual justification, but it also offers to the practitioner a perspective on the basis of which she or he can understand the dilemmas and the problems of today’s agenda. As Parker (1988, p. 3) has argued in the context of residential care, no informed conclusions about the future can be reached without an understanding of key external factors and ‘that, in turn, cannot be done satisfactorily without some understanding and appreciation of those forces that have shaped its history’.