It is very rare for people with physical illnesses to be controlled coercively by medicine on behalf of the state and society.For example, some conditions like multiple sclerosis are difficult to diagnose.Some diagnoses of reported bodily symptoms have unknown or questionable bodily signs.By contrast, social norms shift over time and place, and policies about their violation are subject to the whims of the powerful in society.As a result, Szasz argues that we would be wise to treat psychiatry and its activity in a different way to the rest of medicine.His case is supported by the fact that mental illness is treated in a uniquely coercive manner in most modern societies.By contrast, it is common for mentally ill patients to have their liberty taken from them without trial and for their bodies to be forcibly interfered with.These daily realities in mental health services do give substance to Szaszs original concern about the peculiar character of psychiatric diagnosis and the nature of the treatments the profession typically prescribes.Those like Sedgwick who agreed with Szasz about mental illness as deviance disagreed with him on two fundamental matters.Second, Szsasz set up a crude binary between determinism and moralism, with us being afflicted by physical illness but being fully responsible for what is called mental illness.This moral absolutism about one part of the division is problematic.For example, maybe some of the time those with a psychiatric diagnosis really are impaired in their capacity to be full moral agents.If we are both determined and determined beings, then that assumption should apply to both physical and mental illness.A final point to note about the gauntlet thrown down by Szasz is that it has probably contributed to more recent demands and criticisms from mental health service users about terminology.The use of mental distress, as a preferred alternative to mental illness, is an example here of this point.It suggests that we can be confident that psychiatric diagnosis regularly occurs but not necessarily that it is legitimate, meaningful or valid.Primary care refers to the first point of contact patients have with a health service.Staffed by general medical practitioners and other healthcare workers, it provides an initial diagnosis and treatment and it may be the start of a referral pathway to other services.The importance of primary care for people with mental health problems is discussed.Problems associated with the medicalisation of psychosocial problems in primary care are outlined.Primary care is important for people with mental health problems for three main reasons.Third, in the wake of large hospital closures, most people with a history of psychosis are now living in the community, for most of their lives.Whether or not they return occasionally to acute service inpatient stays, for the most part, primary care will be their point of contact with the health service.This biomedical emphasis in primary care has resulted in two credibility problems for this service response.This discourse suggests that psychosocial problems are not medicalised enough.Thus, from a psychiatric perspective, the problem with primary care is its medical inefficiency.In the recent British mental health policy context, primary care has been charged with improving services to people with mental health problems in two ways.Second, all patients should have their mental health needs assessed.Treatment should then be provided directly or by referral to specialist mental health services.In recent years a number of government initiatives have been evident to boost primary mental health care.Thus, primary care is a site of many contradictions.It deals with psychosocial problems but they are processed and recorded as medical problems.Although mental health problems are diagnosed as illnesses, they are not addressed within a medical framework as convincingly as bodily conditions like heart disease.This point now applies to psychotic patients who previously would have lived most of their lives in large institutions.Primary mental health care is also racialised and gendered.Acute mental health services are accessed by, or imposed upon, people who are deemed to be in immediate need of containment to assess their needs, or to intervene when they are acting in a very distressed, disturbing or perplexing way.The history of acute mental health care is outlined along with its professional advantages to psychiatry.Problems on these units are discussed in relation to their social control function.Alternatives to inpatient care are considered.The 1890 Lunacy Act required that all people entering asylums were detained compulsorily and a certificate of insanity issued.They were certified – a term that is still used in jest in the vernacular today.The 1930 Mental Treatment Act introduced the notion of community care and allowed for voluntary boarders.After the Second World War, the first moves became evident to reduce the size of, or even to abolish, the old large Victorian asylums.However, it was not until the late 1980s that this programme of hospital closures became a reality in most localities.It gave the appearance of scientific medicine coming of age in relation to mental illness.In other words, for as long as the threat of compulsion exists, some patients will be under duress to go to hospital voluntarily.Indeed, as long as lawful compulsory powers exist to admit patients to a facility, then it is impossible to provide an accurate estimate of those who might be genuinely voluntary.By the time that the large Victorian asylums had been closed in the 1990s, the pressure on the small units in general hospitals had increased for a number of reasons.First, the availability of beds was dramatically reduced, as the backstop of the asylum acute admission ward disappeared.Substance misuse increases the chances of chaotic and violent behaviour in psychotic patients.As a result of these aggregating pressures, the ratio of officially recorded voluntary to involuntary admissions was reversed.In the early 1970s, their advocates in the psychiatric profession aspired to offer medicalised treatment centres for people in acute mental health crises.