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THERE IS a grim familiarity in the latest findings of the Inspectorate for Mental Health Services on the standards of psychiatric care. They show that too many residents continue to be housed in antiquated Victorian institutions. In addition, community mental health services have not developed as envisaged in government policy and there is still no sense that a coherent vision and philosophy drives the delivery of services.

The findings are familiar because so little has changed over the years. Mental health services have always suffered from neglect and stigma, but the government insisted this era was drawing to a close when it published its plan to modernise the sector four years ago. A Vision for Changewas adopted as government policy at the beginning of 2006. It had widespread support from all sectors and was accompanied by solemn pledges that resources and political will would be available to ensure the mistakes of the past were not repeated. Old psychiatric hospitals would be closed down and replaced with community-based centres. The concept of a national network of comprehensive, community-based, multi-disciplinary mental health teams would be realised. The voice of service users would no longer be ignored.