Twentieth-century developments in American psychiatry

This article traces the development of psychiatric services from their institutional base at the turn of the century to the enactment of the Community Mental Health Center Act of 1963. Many perceived this legislation, which brought about community based but federally funded psychiatric care, as a radical departure from existing trends; indeed, President John F. Kennedy introduced it as a "bold new approach." In fact, it represented the culmination of a slow, gradual evolutionary development. This article identifies the concepts underlying community psychiatric services and their programmatic elements and specifies their time of origin. The author concludes that while the current federal initiative in community psychiatric care (e.g., CHHCs) may be in jeopardy, its evolutionary nature ensures its continuance in one manner or another.