Victorian pioneers of community care are getting the recognition they deserve. Barbara Millar reports

Henry Hawkins and Thornhill Roxley are not familiar names today, but the Victorian pioneers of care in the community for people with mental illnesses founded a charity which is still going strong 121 years on. To celebrate it has published a history, Community Care in the Making.

MACA (previously known as the Mental Health After Care Association) came into being in 1879 when Reverend Hawkins, chaplain at Colney Hatch Asylum in Middlesex, became concerned about the way patients - and in particular women - relapsed soon after discharge from its care.

He advocated in national journals the establishment of half-way houses 'between the asylum and the world', where women could convalesce, prepare to take up employment and resume 'life's ordinary associations'.

And so the After-Care Association for Poor and Friendless Female Convalescents on Leaving Asylums for the Insane was born, with Thornhill Roxley appointed as its first paid secretary in 1886.

Women were the linchpins of the organisation from the beginning. Not only was it founded to support them, but 'good Christian women' were recruited to provide places in their 'respectable family homes' where ex-patients could recover.

By 1889, 143 'cottage homes' (the half-way houses) had been set up and over 100 people helped in the three years following the organisation's inception.

It was also getting involved in preventive work, with 'some people at risk of becoming insane' being placed in cottage homes. In 1893 it founded the first residential home for mentally ill people in England, at Redhill in Surrey, with spaces for nine people, and in 1894 men were allowed to have access to its services, the name changing to the After-Care Association for Poor Convalescents on Leaving Asylums for the Insane.

By 1897 the organisation reported that only three out of the 147 people helped (2 per cent) had been readmitted to asylums, at a time when the national average was 14 per cent.

By the turn of the century over 30 branches had been set up to raise funds and find, visit and report on standards at local cottage homes. Mr Hawkins died in 1904 at the age of 80. Thornhill Roxley carried on until he resigned because of ill-health in 1915, just after the outbreak of the First World War, when the organisation saw a huge demand on its services to work with shell-shocked soldiers.

In the 1920s royal patronage improved MACA's profile and financial fortune so that, by 1926, it was able to report that it had helped over 2,000 people and had a close working relationship with over 100 mental hospitals.

The outbreak of the Second World War brought more opportunities for people with mental health problems to take up employment and, in 1939, MACA appointed its first employment officer.

Many long-term mental hospital patients were relocated to residential care homes to make way for injured soldiers, and this experiment was an immediate success. MACA's annual report of 1943 states: 'We think this method of caring for suitable chronic patients is worth further exploration and development.'

In the post-war years MACA gradually became the foremost provider of long-term residential care for people with mental health problems. It developed further in the 1970s and 1980s, winning health and local authority contracts for community services, and expanded rapidly in the 1990s, with 400 staff delivering a wide range of services, including employment training, assertive outreach, telephone helplines and advocacy services.

But MACA continues to work to a set of core values which have changed little since 1879. They are values based on respect for the individual and their experience of life, says current chief executive Gil Hitchon.

'People are the way they are because of their life history and the way they have interpreted it.

They are all individuals. The aim is to understand things from their perspective rather than your own.'