Psychoanalysis and the Community Psychiatrist

The practice of community psychiatry requires a variety of professional skills. The community psychiatrist is asked to be a clinician, an administrator, a community organizer, and a mental health consultant. What is more, he is asked to serve in each of these roles in new ways. As a clinician, he is asked to use a variety of approaches, only one of which is traditional individual psychotherapy. As an administrator, he must develop the means for overseeing the operation of a variety of programs and a number of agencies, most of which have functioned quite independently in the past. As a community organizer, he is asked to mobilize the interest and the activity of other professionals and nonprofessionals in his community. As a consultant, he is asked to bring service to the community through other professionals who fit into the category of “care givers” but who are not mental health professionals.

In these various roles, the community psychiatrist is concerned with the prevention of mental disorders as well as with the diagnosis and treatment of these disorders. Efforts at prevention are a major part of any community mental health program. Moreover, it is important to note that the preventive activities of community psychiatry include all three forms of prevention as developed by typical public health practitioners. The community psychiatrist is concerned with primary prevention in that he is much involved in finding ways to reduce the incidence of mental disorder in his community. He is concerned with secondary prevention in that he is responsible for the reduction of the prevalence of mental illness through the provision of early and adequate diagnostic and treatment services. He is concerned, finally, with tertiary prevention in that his responsibilities include long-term care and the reduction of long-term disability.

Each of these roles and functions requires a variety of skills. Central to all of them is the need for a high level of clinical skill. The community p