Nick Bouras

Reflections on the Challenges of Psychiatry in the UK and Beyond


A Psychiatrist’s Chronicle from Deinstitutionalisation to Community Care

A personal testament of events witnessed over the years of major ideological trends in mental health.



Reflections on the Challenges of Psychiatry in the UK and Beyond is a personal journey through British psychiatry, the NHS and academic life for over 40 years. It describes personal experience as perceived by a postgraduate student, practicing clinician, teacher, trainer, researcher and health service manager.

This book presents a personal historical chronicle and a panoramic view of some of the most significant milestones of modern psychiatry. The process of developing mental health services including those for people with intellectual disabilities through a maze of policies, sometimes contradictory, but also with strong ideological, sociological and political encounters proved to be a foremost challenge.

The author examines the complex connections of these processes and he succeeds in giving a comprehensive picture of the mental health map in over four decades. Successes and disappointments are featured throughout Reflections and Challenges of Psychiatry in the UK and Beyond through memories, archives and personal statements.

‘Intellectual autobiographies contribute greatly to historical understanding. Good ones are also pleasurable to read. Reflections and Challenges of Psychiatry in the UK and Beyond captures a period of change in psychiatry. The great and the good are depicted strutting on the metropolitan stage showing the rest of us how things psychiatric should be done. Natural modesty has impeded Professor Nick Bouras from talking about the crucial role he himself played in the changes he describes.’

(Professor G.E. Berrios, Cambridge University)

‘There have been dramatic changes in the way mental health services are delivered in England over recent decades. Professor Nick Bouras gives a personal account of the obstacles and challenges he faced in developing, researching and implementing these; in particular in the field of intellectual disabilities. He records the successes and frustrations of working in a system that does not always have a shared vision. His tenacity and enthusiasm is an example to us all and will encourage and inspire those facing similar issues today.’

(Dr Geraldine Holt, Consultant Psychiatrist in Learning Disabilities, London)

‘An important study of a much neglected field, this exploration of the psychiatry of intellectual disabilities is revealing not only as a personal history but also as an analysis of its clinical development, research challenges and its place in the politics of health. Professor Nick Bouras is particularly well qualified to provide this insightful and evocative account.’

(Professor Edgar Jones, Institute of Psychiatry Psychology & Neuroscience, King’s College London)





Reflections on the Challenges of Psychiatry in the UK and Beyond will be of interest to all mental health professionals, health practitioners, policy makers, commissioners and managers, as well as to lay people. This book can be used in courses for psychiatrists, psychologists, social workers, nurses, therapists, health and social policy.


ISBN: 9781911028413
Publication: 02 February 2017

  • Chapter I: Early Years
  • Chapter II: Mental Health Advice Centre
  • Chapter III: Consultant Psychiatrist
  • Chapter IV: Developing the Service
  • Chapter V: Resettlement Programme
  • Chapter VI: Policy Context
  • Chapter VII: Community Mental Handicap Team
  • Chapter VIII: Specialist Psychiatric Service
  • Chapter IX: Mental Health in Learning Disabilities (MHiLD)
  • Chapter X: Estia Centre
  • Chapter XI: The University Component
  • Chapter XII: The International Dimension


Nick Bouras MD, PhD, FRCPsych, is Professor Emeritus of Psychiatry at the Institute of Psychiatry, King’s College London and Honorary Consultant Psychiatrist at South London and the Maudsley Foundation NHS Trust. He is currently Programme Director of Maudsley International.

Professor Bouras led the research programme of the first Community Mental Health Centre in UK and carried out extensive studies of service monitoring evaluation. He was Consultant Psychiatrist at Guy’s Hospital of South London and the Maudsley Foundation NHS Trust for over 25 years and was instrumental in the re-provision of services from three large psychiatric institutions. Professor Bouras participated actively in the development of community based multi-professional mental health services that have been supporting numerous residential facilities in local communities for people with intellectual disabilities and complex mental health needs, people with chronic schizophrenia, and other neurodevelopmental disorders.

Professor Bouras initiated the development of the Estia (Evaluation, Services, Training, Intervention, Assessment) Centre, ( and remained Director until his retirement. This was and remains an innovative concept combining clinical services, training and Research & Development, jointly funded by the NHS and University. His research has been focused on health service related topics including assessment and clinical effectiveness of specialist mental health services; evaluation of multi-professional training methods; and social and biological determinants of behaviour in psychiatric patients.

Professor Bouras has been a member and held executive positions in several National and International organisations. He has been Editor and member of the Editorial Board of several journals. He has published extensively in community psychiatry and mental health aspects of people with intellectual disabilities. Several of his books have been translated into different languages.


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