Historical applications of the Goldberg and Huxley Pathway to Psychiatric Care Model

John Hall

doi:10.1921/swssr.v25i1.2293

Authors

John Hall Oxford Brookes University, Senior Research Associate, Centre for Medical Humanities https://orcid.org/0009-0005-6547-7920

DOI:

https://doi.org/10.1921/swssr.v25i1.2293

Keywords:

Goldberg & Huxley pathway to care model, mental health care transition decisions, history of British mental health systems

Abstract

The Pathway to Psychiatric care Model was published by David Goldberg and Peter Huxley in 1980, based on practice within the British NHS from 1948, and on epidemiological data mostly from Europe and the USA. The ‘filters’ in the model were derived from assumptions about practice, and levels of care, at that period. This paper explores the implications of applying the model historically to patterns of English psychiatric care firstly from 1834/1845 to 1959, with parallel public, philanthropic and private systems of healthcare; and secondly to patterns of care after c.2000. The model is a powerful conceptual tool for understanding how mental health systems function, and the central importance of referral and transition decisions. This analysis points to the influence of changing ‘regulatory cultures’, at one remove from the immediate clinical encounter, and to the implications of a much wider range of mental health practitioners than in 1980

Author Biography

John Hall, Oxford Brookes University, Senior Research Associate, Centre for Medical Humanities

John Hall is a clinical psychologist by background, and for the past twenty years he has researched in the broad field of histories of mental health services and practitioners.

References

Armstrong, N. and Agulnik, P. (2023) Happenstance and regulatory culture: the evolution of innovative community mental health services in Oxfordshire in the late twentieth century. History of Psychiatry, 34, 1, 64-77. https://doi.org/10.1177/0957154X221136702

Bartlett, P. (1999) The Poor Law of Lunacy. London: Leicester University Press.

Berrios, G. and Porter, R. (1995) A History of Clinical Psychiatry: The origin and history of psychiatric disorders. London: Athlone.

Bower, P. (2002) Primary care mental health workers: models of working and evidence of effectiveness. The British Journal of General Practice, 52, 484, 926-933.

Cohen A (2005) Primary care and mental health. in A Bell & P Lindley (Eds) Beyond the Water Towers. London: the Sainsbury Centre for Mental Health (pp.83-90)

Cohen, A., Tylee, A., Thurston, L. and Hall, J. (2023) Witness Seminar: History of Primary Care Mental Health in England 1948-2019. Royal College of Psychiatrists. [Witness seminar - History of primary care mental health in England 1948-2019(rcpsych.ac.uk)]

Digby, A. (1999) The Evolution of British General Practice 1850-1948. Oxford: Oxford University Press.

Gask, L., Dowrick, C., Klinkman, N. and Gureje, O. (2018a) Diagnosis and classification of mental illness: a view from primary care. in L. Gask, T. Kendrick, R. Peveler and C.A. Chew-Graham (Eds.) Primary Care Mental Health. Cambridge: Cambridge University Press (pp.70-85).

Gask, L., Kendrick, T., Peveler, R. and Chew-Graham, C.A. (Eds.) (2018b) Primary Care Mental Health. Cambridge: Cambridge University Press.

Glasby, J., Tew, J. and Fenton, S.-J. (2021) UK mental health policy and practice. in G. Ikkos and N. Bouras (Eds.) Mind, State and Society: Social history of psychiatry and mental health in Britain 1960-2010. Cambridge: Cambridge University Press (pp.93-102).

Goldberg, D. and Huxley, P. (1980) Mental Illness in the Community: The pathway to psychiatric care. London: Tavistock.

Hall, J. (2005) Balancing the transitions between local generalist and tertiary specialist commissioning of adult services. Mental Health Review Journal, 10, 2, 23-26. https://doi.org/10.1108/13619322200500016

Hall, J. (2022) From Poor Law Lunacy to Primary Care Mental Health: A Gap in the Historical Literature. Royal College of Psychiatrists History of Psychiatry Special Interest Group: News and Notes History of Psychiatry. No. 14, April, 33-38 [also available on open access at https://www.rcpsych.ac.uk/docs/default-source/about-us/library-archives/archives/archive---witness-seminar---history-of-primary-care-mental-health.pdf?sfvrsn=5005ac0e_1]

Hall, J.N., Baker, R.D. and Hutchinson, K. (1977) A controlled evaluation of token economy procedures with chronic schizophrenic patients. Behaviour Research and Therapy, 15, 3, 261-283. https://doi.org/10.1016/0005-7967(77)90023-7

Killaspy, H. (2006) Psychiatric out-patient services: origins and future. Advances in Psychiatric Treatment, 12, 5, 309-319.

Longmate, N. (2003) The Workhouse. London: Pimlico.

Loudon, I. Horder, J. and Webster, C. (1998) General Practice Under the National Health Service, 1948–1997: The first fifty years. Oxford: Clarendon Press.

Mishra, R.C. (1969) A History of the Relieving Officer in England and Wales from 1834 to 1948. Unpublished PhD thesis, LSE, University of London.

Parry-Jones, W.L.l. (1972) The Trade in Lunacy. London: Routledge and Kegan Paul.

Rolph, S., Atkinson, D. and Walmsley, J. (2003) ‘A Pair of Stout Shoes and an Umbrella’: the role of the mental welfare officer in delivering community care in East Anglia: 1946–1970. The British Journal of Social Work, 33, 3, 339-359. https://doi.org/10.1093/bjsw/33.3.339

Savage, G.H. (1890) Insanity and Allied Neuroses. Philadelphia: Lea Brothers.

Tooth, G.C. and Brooke, E. (1961) Trends in the mental hospital population and their effect on future planning. The Lancet, 277, 7179, 710-713.

Turner, T. (2021) Clinical psychiatric perspectives on community and primary care psychiatry and mental health services. in G. Ikkos and N. Bouras (Eds.) Mind, State and Society: Social history of psychiatry and mental health in Britain 1960-2010. Cambridge: Cambridge University Press (pp.222-230). https://doi.org/10.1017/9781911623793.025