What leads to innovation in mental healthcare? Reflections on clinical expertise in a bureaucratic age

Abstract

This paper considers a witness seminar in which healthcare professionals discussed working on an acute admissions ward run along therapeutic community lines from the 1960s to the 1980s. Participants remarked that older styles of working are ‘unimaginable’ today. This paper discusses why. Literature from the humanities and social sciences suggest healthcare is reactive, reflecting wider cultural changes, including a preference for a more bureaucratic, standardised, explicit style of reasoning and a high valuation of personal autonomy. Such a reflection prompts questions about the nature of professional expertise, the role of evidence and the importance of the humanities and social sciences.