Community psychiatry: what should future psychiatrists learn?

Community psychiatry training is required by all adult psychiatry residency training programs. Unlike other core elements of training, the specific content is not clearly articulated, leaving program design and content up to individual programs. At the same time, the meaning of "community psychiatry" is increasingly in the eye of the beholder; traditional structures and systems have lost funding, services are more diffuse, and the traditional medical model is becoming less valued. In this column we describe an approach to training in community psychiatry that is intended to prepare future psychiatrists for the clinical and systems challenges they will undoubtedly face and that achieves this goal through trainees' caring for an especially vulnerable subpopulation--homeless individuals with severe and persistent mental illness. We describe how this model teaches residents to think simultaneously at both the individual and the systems levels and enables them to understand the critical need to use nontraditional treatment approaches in order to provide comprehensive care for this marginalized population. We believe that this clinical and training paradigm can be replicated and might guide other residency training programs in their approach to teaching community psychiatry.