This paper reviews the Cuban mental health system from a descriptive organizational perspective. It focuses on (a) the in terface between mental health, public health, and the socio- political structure; (b) inpatient treatment and rehabilitation programs; (c) the use of social networks in support of the dis charged patient; (d) community care, including descriptions of sectorization and dispensarization systems; and (e) primary to tertiary prevention strategies.

This review is reported in two parts. This first article lays the groundwork for the analysis of psychiatric social epidemiology by (a) drawing in broad strokes the developmental phases followed by the Cuban Revolution, as the contextual base on which to build this analysis; (b) exploring the development of the field of psychiatric epidemiology in the Island; (c) delineating the development of human and material resources in health and mental health; (d) reviewing issues of access to care by traditionally underserved populations; (e) exploring gradual changes in the character of mental health care as reflected by service utilization patterns; and (f) discussing changes in the attitude of the population towards mental health and illness, as reflected by pathways to care. Overall, this section provides evidence of a rapid development and deployment of resources in this domain and of their egalitarian distribution and general accessibility to the population.

This article explores social epidemiological issues in the morbidity of psychiatric dysfunction, and in the mortality associated with socioenvironmental stress in Cuba. It builds on a review of the contribution of factors such as social status and social integration or marginality in a revolutionary society. This article explores relevant issues in the epidemiology of heart disease, cirrhosis of the liver, accidents, homicide, and suicide mortality. The review suggests a pattern of increasing epidemiological costs that seem to implicate the Island's process of social and economic development. These costs are contrasted to marked benefits in several domains, which appear to respond to economic democracy, and to effective planning and policy development.