Psychoanalysis and Community Mental Health*

In considering the possible contributions of psychoanalytic theory and practice to community mental health it may be useful to review some of the elements of community mental health services. They are generally discussed in relation to the model of a hospital-related community mental health center, a facility serving as the central core of care (frequently with community-based satellite services). However, these features apply, equally as appropriately, to the more innovative (and less common) model of a planned network of integrated community mental health services.

A basic premise of community mental health is that responsibility should be assumed for the health needs of a defined population. Attention is given not only to current cases and current needs, but there is also concern with potential cases through efforts at primary prevention. This responsibility includes provision of a full range of coordinated services in quantities sufficient to meet the mental hygiene needs of all persons in this designated population, regardless of whether or not they have been labelled patients by themselves or by others. In large cities the catchment or service area concept, as developed, has only fortuitously matched the boundaries of existing neighborhoods, even though the aims of the provision of services on a regional basis are not only to ensure that they are both available and accessible, but also responsive to locally identified needs and expressed demands. Ideally, programs draw upon the culture and life style of the