1. The effects of significant mental health problems reach past the individual into services, the economy and families.
2. Society has to organise and pay for care, absorb the work that is lost, and lean on unpaid carers to cover the gaps.

Care in the community

1. The 1959 Mental Health Act started the shift by allowing voluntary treatment, and in 1961 the Minister of Health announced that the large mental hospitals would close.
2. The NHS and Community Care Act 1990 made local councils responsible for assessing what a person needs and arranging the care.
3. Psychiatric bed numbers in England fell from roughly 150,000 in the mid-1950s to under 20,000 today, so almost all care now happens outside hospital.
4. In place of a long stay, a person is supported by a community mental health team of psychiatrists, nurses, psychologists and social workers.
5. A community psychiatric nurse visits at home, checks how medication is going, and can pick up a relapse early.
6. A crisis resolution and home treatment team can step in at short notice and support a person through a crisis at home.
7. Supported housing, day services and the GP cover the everyday parts, and the Care Programme Approach names one care co-ordinator to hold it all together.

Evaluating care in the community

1. Society gains when a person stays near family, keeps a tenancy, and avoids the loss of everyday skills that a long institutional stay causes.
2. Community support also costs less per person than a hospital bed, so the same budget reaches more people.
3. The model needs enough trained staff, and shortages show up as long waits between a referral and a first appointment.
4. Where support thins out, people are readmitted again and again, a pattern often called the revolving door.
5. Some people lose contact with services altogether, and insecure housing or homelessness follows.
6. Police and ambulance crews then end up as the first responders to a mental health crisis.
7. Well-funded community care helps a great many people recover and live independently, so the model is judged on how it is resourced.

The economic cost

1. Someone who is unwell may need time off work, so the economy loses the output they would have produced.
2. Employers carry the sickness absence, the cost of recruiting a replacement, and reduced output from staff who are at work but struggling.
3. The NHS pays for appointments, medication, talking therapy and hospital beds.
4. The welfare system pays benefits when a person cannot work, and councils pay for social care and supported housing.
5. The Centre for Mental Health has put the cost to England at well over £100 billion a year.
   1. Treat a figure like that as an estimate, because it adds spending, lost output and a value placed on reduced quality of life.
6. Early treatment lowers the total, since a problem caught in a ten-minute GP appointment costs far less than a crisis admission.

Mental health problems and crime

1. The large majority of people with a mental health problem never commit an offence.
2. People with a severe mental illness are considerably more likely to experience crime than the general population is.
3. Where a small association does turn up, it usually tracks other factors such as untreated illness, substance use, poverty or having no support in place.
4. News coverage that pairs a diagnosis with a violent crime makes the link look far larger than the evidence supports, and that coverage is itself a source of stigma.

The load on families and carers

1. Relatives provide most day to day support once care moves into the community, and they are usually unpaid.
2. Some cut their hours or leave work to do it, which costs the household its income and the economy its output.
3. Young carers may miss school or fall behind, so the effects pass into the next generation.
4. Carers are more likely to become unwell themselves, which is why councils offer a carer's assessment and respite breaks.

Turning this into marks

1. When two effects on society are asked for, make them genuinely separate rather than one effect rephrased.
2. Name the specific service or law, such as the community mental health team or the NHS and Community Care Act 1990, because a general reference to support in the community does not secure the knowledge mark.
3. The mark most often lost is describing an effect on the individual when the question asked about society.