Abstract
The practice of psychiatry and mental health services is influenced by social, economic and cultural factors. In this paper evidence from the Netherlands is presented. Like many other countries, shift from asylums to community care has meant a number of significant challenges. Changes in social and health policies and financial circumstances has led to changes in healthcare delivery. In addition these also impact upon training. Lessons from these changes are many and we need to learn from these so that patients can get the best treatments.