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.

Classic Text No. 133: 'Maxwell Jones and the Therapeutic Community', by David Millard (1996).

This text was David Millard's departing gift to a field to which he had contributed for 30 years, as practitioner and later as Lecturer in Applied Social Studies and editor of the International Journal of Therapeutic Communities. Charting the chronology of Maxwell Jones's career as a world-renowned psychiatrist and therapeutic community pioneer, Millard contrasts Jones's contribution at Mill Hill with Tom Main's at Northfield. Jones's most distinctive contribution was allowing patients to become auxiliary therapists and freeing nurses from the nursing hierarchy. Focusing on a subset of therapeutic communities in adult psychiatry, Millard's paper is not an academic history of therapeutic communities as such. The roles of happenstance and positive deviance are demonstrated in the way change occurs in therapeutic communities. The 'charisma question' is briefly explored.