The Community Psychiatrist: Hamlet, King Lear, or Fishmonger? Traditional vs. Nontraditional Roles and Settings

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Abstract

Community psychiatry has changed greatly in the 35 years since the passage of the Kennedy Community Mental Health Center legislation in 1963. The authors trace the history of the community mental health system and discuss the impact of increasing deinstitutionalization on the system, in particular the need to provide more extensive services to a more severely ill population. They then describe the traditional clinical and administrative roles played by the community psychiatrist, before turning to the more innovative, nontraditional roles that are becoming increasingly important in community psychiatry. The authors describe the roles community psychiatrists fill in outreach psychiatry, a homeless shelter, a residential care facility, a jail or prison, commitment services, and on a PACT team. Case examples are used to illustrate the problems psychiatrists face and the skills required in each setting.

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