Linked changes in mental, health service delivery and psychiatric education

In sociocultural perspective, this paper traces the impact of deinstitutionalization and the community mental health movement on the mental health service delivery system and subsequent effects on psychiatric training. Examples are given of changes at the national, state, and local levels. The current need is for new initiatives to interest residents in public sector psychiatry and in work with the chronic patient. Issues discussed include new conceptions of the parameters and roles of psychiatric treatment, involvement of families and other support groups in patient care, comprehension and applications of cultural values, and new functions of the state hospital in the continuum of care as locus of specialized services and of professional training and research.