[Mental health community centers in the United States]

After defining the concept of the Community Mental Centers and giving an overview of the principles, the author describes the five most needed ways for the operationalization and the implementation of the community approach in mental health care. The results, i.e. the successes, of the community mental health programme in the USA are discussed and also the various shortcomings: private psychiatrists and general practitioners are not integrated enough; overestimation of the need for the number of psychiatric beds; need for cost analysis of the consultation and education part of the programmes in connexion with the need for adequate reimbursement; an evaluation programme should have been built in from the beginning; with the tremendous increase in personnel costs and the general inflation of cost price, some parts of the programme are not financially competitive with the private psychiatric practice; two parallel systems still emerge, the CMHC and the State hospitals, frequently with not enough collaboration; and finally, the "yavis" phenomenon with neglect of the unwanted, difficult, chronic patient, especially the defected schizophrenics.