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This article is based on the premise that social conditions and culture influence mental illness. Some community psychiatrists are concerned with treating the community, i.e., changing social circumstances; others attempt to deal with the individual through various treatment techniques. The author is primarily concerned with the methods of organizing and delivering the best psychiatric service at the lowest cost. Various aspects of this problem are thoughtfully discussed.
Important new approaches to treatment provide for crisis intervention and brief therapy. Local responsibility for seriously ill patients as opposed to state responsibility is advocated, as well as rapid admission and discharge procedures in local general hospitals. Rapid return to the home and community, even if this involves multiple hospitalizations, is preferable to long hospitalizations in state institutions. The author attributes current failures in community psychiatry to setting unrealistic goals, to the shortage of staff, and to treating selected 'cream puff' patients while ducking the treatment of seriously ill schizophrenics and senile patients. The problems of planning, governing, and community involvement are discussed. Zusman believes that psychiatrists would prove most useful as diagnosticians and supervisors of nonmedical personnel who would provide direct treatment.