In the post-institutional era of mental health care how are we to conceptualize "community care" and "the mental patient"? There are those who look back to the institutional era with a fond, usually rose-tinted, nostalgia; for others deinstitutionalization remains an ideal rather than a reality. The literature on psychiatry and mental illness shows increasing divergence. Even mainstream services have adopted "recovery" as a motif, there are new biological discourses, and for many people with mental illness, a forensic identity as either patient or criminal. The movement to community care has had limited success in dismantling the mental patient as different and other. Hester Parr`s contribution to this issue uses the conceptual tools of geography to open up debate about the social space of the person with mental health problems, and in so doing to move beyond debate about "institutional spaces and enclosed medical identities" Mental Health and Social Space. Towards Inclusionary Geographies? re-examines the identity of people with mental illness, especially the transition "from inert non-citizen to valued and relational social agent."

Two theoretical chapters provide the background against which Parr reports empirical studies of mental health in various social spaces, with a final chapter looking forward to new ways of thinking and practice. The social spaces are widely divergent, ranging from rural villages of the Scottish Highlands to the Internet. Each offers opportunities and risks in the task of forging an identity as a person with mental illness. The concept of space is central to this book, beginning with the observation that the asylum enterprise can be understood as one of segregation, and the creation of spaces of exclusion. Debate over moral and medical models of the asylum ignores their common feature of spatial and conceptual differentiation. What Parr also points out is that many of the critical histories of psychiatry have also characterized the mental patient as passive, and have ignored the agency seen in small acts of resistance, exercised even by institutionalized asylum inmates. Interestingly, Erving Goffman is cited as one whose work recognizes the operation of agency, even within the "total institution." Parr quotes from Asylums:

The patient curling up at the window, looking outside through the bars, pressing the nose of his whole body against the outside, and in this way somewhat removing himself from the ward, and somewhat freeing himself from its territorial restriction.
The second chapter explores the development of community care in the UK, leading to a discussion of how "social inclusion" of people with mental illness might lead to identities beyond those derived from mental illness or use of mental health services. Parr makes much of the disproportionate expenditure on inpatient compared to community services, and especially compared to expenditure on the large majority of people with mental illness within primary care. While this economic analysis is interesting, it tells only a partial story, and begs the question of the extent to which the mental health sector should cater for the whole spectrum of people with mental illness. Given the tendency of the mental health sector to develop silos, it seems positive that the majority of people with mental illness receive care in the primary sector. In terms of the wider historical perspective, the global emergence of mental health as a major issue in primary care is something that requires close analysis, especially as this is a new claim for resources, which arguably should not be made on a mental health budget already struggling to meet demands for new services. Parr argues that "community" is largely a rhetorical device for mental health policy, with little direct evidence that reinvestment has been substantially diverted away from institutional psychiatric care, despite the "widespread emergence of community mental health teams." {p.
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