The private sector of psychiatry has become increasingly involved in providing mental health care for the country's lowest socioeconomic population. Private practitioners, as well as psychiatrists in hospitals and outpatient clinics, have become more participant as the Medicaid fee scale has slowly risen. Most providers, however, are still turned off by long delays in payment and the difficult therapeutic challenge of treating this population. This paper describes a clinical orientation and clinical techniques used in the treatment of the socioeconomically disadvantaged that combine sociological and psychiatric insights.

This presentation is based on 12 years of experience with a poverty population after New York City acquired a prepaid psychiatric contract for about 36,000 of its welfare recipients with the Health Insurance Plan of Greater New York (HIP). I will also briefly present the results of a survey study of Medicaid patients' evaluation of their treatment.