Psychiatrists have been predicting this crisis for years. As the old-fashioned mental hospitals began to close and care in the community initiatives burgeoned, a strange no-man's land was created. Inpatient units were not real therapeutic spaces but rather, as Royal College president Dinesh Bhugra put it, crisis stabilisation centres. The patient had to be returned to society, freeing up a bed and allowing a swift and efficient service. Today's premium on shallow and visible outcomes meant that what mattered was balancing the books, as if proving to one's managers that one ran a quality service had become more important than actually running one. This shift is reflected in the NHS joke that if what used to matter was losing a patient, today it is losing the patient's notes.
As healthcare became subordinated to short-term and economically profitable goals, the role of wards was itself to change. Admission would become linked in most cases to physical containment. A patient would be admitted because they posed a physical risk to themselves or others. Many psychiatric workers have described this radical redrafting of their profession as no longer a supportive project of care but a damage limitation exercise.