Psychiatry before the year 2000: the long view

The author assesses psychiatry's accomplishments during the past quarter century and the challenges the profession faces in a changing political, economic, and medical environment. He believes that several of the policy decisions of the early 1960s, particularly the deinstitutionalization movement, were based on faulty premises and that their consequences hold valuable lessons for future policy planning. Among psychiatry's major challenges are advancing its knowledge base through intensive research; increasing the accessibility and quality of existing therapeutic services despite constrained resources; and enhancing confidence of the voting and paying public, including other physicians, in the field's unique capabilities. Such confidence will be conditioned on a rigorous redefinition of the boundaries of psychiatry, acknowledging both the field's limitations and its responsibilities to other than the "traditional" psychiatric patient.