Happenstance and regulatory culture: the evolution of innovative community mental health services in Oxfordshire in the late twentieth century.

This paper uses co-produced historical material to explore the evolution of two innovative mental healthcare institutions that emerged in Oxfordshire in the 1960s. We highlight how the trajectories of both institutions were driven by chance events occurring within social environments, rather than emerging out of evidence or policy initiatives. Both institutions found a role for spontaneity and an openness to chance in the way they worked. We argue that this kind of institutional history would be unlikely today; the paper develops and uses the concept of regulatory culture to explain why. We suggest that the role of regulatory culture has been neglected in the history of psychiatry.

The development of a creative work rehabilitation organisation.

Work as therapy has a place in mental healthcare, but there is disagreement about how and why it might be helpful, and how best to conceptualise or represent those benefits. Over the last 50 years, occupational and industrial therapy sheltered workshops have been key elements in the provision of work activities in psychiatric settings, and community-based horticultural activities and creative craft work have offered additional approaches. Using archival material, interviews, witness seminars and personal reflections, this article charts the birth and initial growth of Restore, a charity providing creative work-based services in Oxfordshire between 1977 and 1988. Although Restore might be understood as a response to national trends in mental healthcare policy and research, its trajectory reflects local contingencies.

Innovation in mental health care: Bertram Mandelbrote, the Phoenix Unit and the therapeutic community approach.

Bertram Mandelbrote was Physician Superintendent and Consultant Psychiatrist at Littlemore Hospital in Oxford from 1959 to 1988. A humane pragmatist rather than theoretician, Mandelbrote was known for his facilitating style of leadership and working across organisational boundaries. He created the Phoenix Unit, an innovative admission unit run on therapeutic community lines which became a hub for community outreach. Material drawn from oral histories and witness seminars reflects the remarkably unstructured style of working on the Phoenix Unit and the enduring influence of Mandelbrote and fellow consultant Benn Pomryn's styles of leadership. Practices initiated at Littlemore led to a number of innovative services in Oxfordshire. These innovations place Mandelbrote as a pioneer in social psychiatry and the therapeutic community approach.

The processes and context of innovation in mental healthcare: Oxfordshire as a case study.

This article introduces the four following articles and the Classic Text. They describe the development of a sequence of innovative local mental health services in Oxfordshire, and explore the processes of innovation, led by the humane pragmatism practised by Dr Bertram Mandelbrote, who was Physician Superintendent at Littlemore Hospital in Oxford from 1959 to 1988. The articles describe emerging patterns of therapeutic community practice, and trace the events leading to a set of discrete service developments outside the hospital. Together, they suggest a positive role for chance in these developments, and a focus on the then prevailing national and local regulatory culture. The Classic Text by David Millard provides an overview of the origins of the therapeutic community movement.