An international comparison of two systems of community mental health care

A neighbourhood health centre in the US is compared with the mental health services in an area of the UK. Patients with severe, but long-standing psychiatric illnesses, or patients with transient emotional problems are likely to be treated by a general practitioner in London and by non-medical mental health specialists in Boston. These patients receive more overall care, more specialist, non-medical care but make as many visits to a medical provider, other than a psychiatrist, in Boston as they do in London. Psychiatrists see more acutely ill patients for a shorter time than non-medical specialists in both places, and in both Boston and London there is a highly selective referral process which results in psychiatrists from both areas seeing approximately the same proportion of the population of their catchment areas. The integration of these findings with community attitudes in planning services is discussed.