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This paper looks at the evolving nature of mental health services. While there has been a shift from asylums to care in the community in recent decades, what is now needed is another shift of acute inpatient psychiatric care, away from psychiatric units to community hospitals and other community settings. It is argued that this would be a further step forward in the evolution of mental health services as it would benefit the service users, their families, carers and staff working in acute psychiatric inpatient units.

The terms are not synonymous; their differences are mainly of function and areas of administration. Community Health is used in national health service law; environmental health to describe the residuum of health functions remaining with local authorities after the first NHS/Local Government reorganization of 1974. Previously, they were all embraced in the term public health, known for a century or more, with little attention to divisions and in the field of administration, all local authority between county and district councils. In the dichotomy created by the reorganization, the personal health services, including the ambulance service, may have dove‐tailed into the national health service, but for the remaining functions, there was a situation of unreality, which has persisted. It is difficult to know where community health and environmental health begin and end. From the outside, the unreality may be more apparent than real. The Royal Commission on the NHS in their Report of last year state that leaving environmental health services with local authorities “does not seem to have caused any problems”—and this, despite the disparity in status of the area health authority and the bottom tier, local councils.