History tells us that the broader values of society can be just as important as those of psychiatry itself in shaping the way people with mental illness are treated. Historical scholarship also alerts us to the need to be circumspect about taking society’s self-declared values at face value, an example being the humanitarian reform of the care system for the mentally ill during the Victorian era where harsh and discriminating morality and a growing intolerance of society towards the marginal have also been demonstrated. Historically, in the UK, doctors have repeatedly found themselves limited in their ability to build a person-centred, therapeutic relationship with their patients by circumstances that were beyond their control, for example the overcrowding and strict legalism of the asylum system.

From the twentieth century onwards, there have been periods when society turned to psychiatry for advice about normal life. Anti-psychiatry emerged during a period when the idea that psychiatry could be a tool for social adjustment was under growing criticism; individual freedom began to be prized over conformity; and the service user movement started. One important legacy of the anti-psychiatry criticism is that psychiatry has become much more cautious about taking a public role on values.

Current and historical practice, personal life history, and culture have a significant impact on the values of practitioners in psychiatry. Most psychiatrists have a strong medical identity but recognize that to be a good clinician they need more than just their biomedical knowledge and skills.

The new UK training curricula reflect the changing value landscape, shifting away from the biological and the psychological and the increasing emphasis on safeguarding. Now explicitly included are VBP principles such as partnership; person-centred care; practice being based on both evidence and values; multidisciplinary working; a model drawing on the social sciences, neurosciences, and the humanities; and clinicians needing to understand the impact of culture, religion, and social systems. Co-production, the doctor–patient power imbalance, protected characteristics, the relevance of the history of psychiatry, and sustainability appear as new additions.

The media portrayal of psychiatry helps the public to understand mental illness and psychiatry, shapes public attitudes and stigma, influences treatment-seeking, scrutinizes how people with mental illness are treated by psychiatry and wider society, and has the potential to protect (but also to harm) people. Despite some improvements in recent decades, there are still examples of coverage maintaining negative stereotypes, and appropriate guidelines are needed.