Psychiatric role conflicts in the neighborhood health setting

The current movement of psychiatrists toward the health care system, and away from community mental health, has led to increased psychiatric presence in neighborhood health centers. Neighborhood settings confront the traditionally trained psychiatrist with role and value conflicts, some of which parallel those experienced in community mental health. These conflicts include definition of professionalism, the nature of psychotherapy, and hierarchical power. Other conflicts are specific to the neighborhood health setting, including the place of confidentiality, multidisciplinary relations, and the medical model and remedicalization in psychiatric practice. Residency training must be altered to adequately prepare psychiatrists for these new roles.