America's

new

psychiatric frontier

America is

suffering from an acute shortage of psychiatrists, and recruitment literature and techniques are now being aimed at high school students. At the same time, to make up for the shortage, other workers in the mental health field are being called on to step into the breach. A report from Minnesota.

founding of State asylums. But now, one of the most important developments is the drive to return this responsibility to local communities with populations of between 75,000 and 200,000 people. The second historical factor is the persistent influence of the frontier in American life. The frontier is the place where anything is possible?the place of American

few elements in American history that highlighted in understanding the health care scene today. The first is the tradition of States' Sovereignty. Over a hundred years ago, responsibility for mental health care was given up by the villages, There should

are

a

be

towns and counties to the

states, and this led

to the

invincibility.

More recently, in the Kennedy and Johnson years, there has been a loosening of long-dammed currents. The result is a string of legislation that is revolutionary in its impact. In particular, there have been the bills to establish comprehensive community mental health centres, to provide facilities for mental retardation and to set up Medicare. Minnesota State is one of the nation's great medical centres. The mental health programme is organised in the Department of Public Welfare, and in the period 1960-5 the number of community mental health centres increased from 13 to 22, and covered 90 per cent of the state population by June 1965. Minnesota's very well developed community mental health services programme was established by the State in 1957, but it is not 'comprehensive', according to the definitions of the Kennedy legislation. Tw new centres are being planned to establish comprehensive programmes, including in-patient services, if remote areas?over a hundred miles from the nearest

psychiatric hospital. Also, plans for menta' are on the threshold of really exciting developments, through federal funds, an effective parents' organisation and powerful support from the State

retardation

State Government.

Shortage of psychiatrists Medicare will have strong, though unpredictable effects on geriatric services in State mental hospital5' There is also the vexing problem of manpower f?f all these programmes. Psychiatrists are in the most urgent shortage, but the basic problem is the 1 of prestige accorded to public service. To deal with thi5 situation, recruitment literature and techniques afe being aimed at high-school students, the Nations' Institute of Mental Health is supporting much pf?' fessional training, and responsibility is being dele' gated to other professional groups. There are serious questions of how far medical

psychiatric responsibility can be delegated away, t>ul much has been done by in-service training and utih' sation of front-line groups at a local level. The5* include welfare workers, clergy, teachers and health nurses; there has also been greater use 0 volunteers and non-medical administrators, afl' Minnesota has been a leader in these methods. Th1; is part of American 'invincibility'?if we don't hav'? psychiatrists, we will find ways of running oljt programmes without them. In fact, we stand at [ turning point and, in my view, the outlook 1

pub^

optimistic.

America's New Psychiatric Frontier.

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