An evidence-based approach to reducing discrimination would seek a range of alternatives to the 'mental illness is an illness like any other' approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice.

There is mounting evidence that British service users face pervasive discrimination in areas of life ranging from work to parenting, insurance to driving licenses. Some studies suggest that certain forms of discrimination have increased during the 1990s, perhaps because of saturation media coverage of the supposed- but not actual- rise in homicides committed by people with mental health problems. One of the key concepts used to investigate the problems that users of mental health services face in their relationships to other people, and to society at large, is 'stigma'. This concept is used to frame questions of public attitudes about mental illness, users' self-perceptions and the unfavourable treatment they receive. It is often stated or implied that if we can break down 'stigma' we can transform users' position in society, their opportunities and wellbeing. This paper examines the limitations of both the concept of 'stigma' and the way it is applied, and reviews the growing literature on discrimination, which is seen as a more promising model on which to base social change.

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Brown Brothers for the Ellis Island illustrations in Chapter 3. Gary Brookins for his cartoon, depicting a service user as an axeman, first published in the Richmond Times-Dispatch, Virginia, May 1997, and reproduced in Chapter 10. Health Education Authority for the Mind postcards reproduced in Chapter 11. Every effort has been made to trace all the copyright holders but if any have been inadvertently overlooked the publishers will be pleased to make the necessary arrangements at the first opportunity.

This paper describes a survey of British Community Mental Health Centres (CMHCs). CMHCs are by far the most visible manifestation of the implementation of community mental health care policies of the 1980s. While these centres have demonstrated achievements in terms of accessibility, co-ordination and responsiveness to clients, they have also been bedevilled by ambiguity. The vast majority of CMHCs aim to serve the needs of all forms of mental illness within their catchment area, yet in practice, they have frequently failed to meet the needs of people with long term severe disorders and concentrate instead on providing assessment and counseling services for neurotic and transient situational disorders. It appears that this is a function of an early failure of multidisciplinary teams to delineate boundaries and priorities. If the British CMHC movement sharpens its focus and combines this with a determination to address the complexities involved in both rationing and enhancing choice, it could begin to improve upon rather than simply repeat the history of similar developments in America.