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This chapter explores how the policy of psychiatric deinstitutionalisation transformed the nature and intended functions of employment for people with mental health problems in post-war Britain. It focuses on industrial therapy, which hospitals implemented as part of rehabilitation programmes designed to prepare long-stay patients for discharge. This involved patients undertaking industrial sub-contract work in spaces designed to resemble a factory environment. The chapter considers two earlier developments which informed the ethos of industrial therapy; the system of rehabilitation designed to meet the needs of disabled soldiers during the Second World War, and occupation and employment schemes developed for people with learning disabilities. It explores the operation of industrial therapy units, which had been established in most British psychiatric hospitals by the 1960s, and the creation of complementary extramural facilities. Finally, the chapter evaluates the tensions between individual therapeutic needs and labour market requirements which came to the fore in industrial therapy, before examining how the industrial therapy model came under pressure due to changing social and economic circumstances in the late twentieth century.

This chapter brings together the main themes of the volume. It argues that deinstitutionalisation and community care should be understood as distinct policies – one should follow on from the other, but this has not happened. These policies which have been adopted across the globe were driven by a combination of fiscal conservatism and progressive idealism. Fiscal conservatism was, for most of the period, the dominant force. Community care has become discredited, but it can be reinvigorated by a call to the progressive idealism that underpinned it.

This chapter outlines the development of the policies of deinstitutionalisation and community care. It discusses the work of theorists including Goffman and Foucault, who were critical of the oppressive nature of the asylum regime. The chapter concludes with a discussion of the failings of community care in the 1980s and 1990s. It argues that a moral panic led to the introduction of more restrictive policies and a focus on risk.

This chapter considers the history of people with intellectual disabilities in Iceland, paying particular attention to the last quarter of the twentieth century when ideas about a normal life began to influence Icelandic disability policy and legislation, which has emphasised social equality and participation for over 30 years. The first half of the twentieth century can be characterised by negative social perception and isolation at institutions. The ´professional community´ pursued aggressively restrictive meassure such as controlled marriage, sterilization and segregation through institutionalization. During the 1960s and 1970s ideologies (sometimes problematic) of normalization and social role valorisation replaced ideas of segregation and institutionalization, calling for a ‘normal life’ for people with intellectual disabilities and advocating their right to take part in regular community life. Historically they played a huge role in de-institutionalization. However, often there was a gap between experiences of people with intellectual disabilities and the normalization principle which assumed that people with intellectual disabilities should have the right to self-determination and to a normal life.