PubMed · 474830
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D Ames. 1979. A second retreat?. https://doi.org/10.1176/ajp.136.9.aj13691229
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The purpose of this paper is to describe the psychiatrist's role in community mental health programs, beginning with the evolution of psychiatric involvement in community mental health centers (CMHCs). There is a discussion of the current state of psychiatry in community mental health programs with descriptions of the types of roles psychiatrists occupy and their thoughts about those roles. The concluding sections focus on the ways psychiatrists can be utilized in community mental health programs so that both the psychiatrist and the agency benefit and are satisfied.
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Changes in the de facto system of mental health care in the last decade reflect organizational and entrepreneurial responsiveness to changes in health policy, not mental health policy. Various other actions described here reduced statutory or institutional leadership roles in mental health and increased the pace at which mental health policy was becoming dependent on health policy. In turn, U.S. health policy in the 20th century has been inherently flawed. The short-term general hospital--the "doctors' workshop"--emphasizing acute care and surgery, has been the cornerstone of U.S. health policy throughout the 20th century. The mimicry of health services by mental health leads to demonstrably more expensive and less effective mental health care and dooms mental health policy to failure.