The university and community mental health: A new trend?

Abstract

In recent years community psychiatry has come under attack. Critics contend that because community psychiatrists are economically dependent on the government, the government can establish a hegemony over mental health ideology and practice and thus can turn community psychiatry into a vast social control system. They also assert that community psychiatry is a rapidly expanding mode of practice. My aim here is to question both claims by showing that (1) even if community psychiatrists are on government payrolls, they, in turn, do not exercise control over the quasi-psychiatric personnel who constitute the backbone of community psychiatry; and (2) if measured by the rate of increase in training programs and the allocation of funds for primary prevention, community psychiatry probably is not expanding at all. If anything, it may be contracting and (3) at least in one area of the country may be retrenching on a new institutional base--namely, the university--which critics in general, might find even more alarming. CONTROL Leifer (1966) reports that about 75% of all psychiatrists spend some time working for the government, that only 54% spend some time in private practice and of those, only 40% spent more than 35 hours per week in private practice. This is in marked contrast to all other medical practitioners, most of whom engage exclusively in private practice. Over and above this general connection between psychiatry and government is the specific connection between the community psychiatrist and government. By and large, these practitioners are completely on government payrolls, earning their money by administering, directing, or creating public programs. Some observers fear that psychiatrists who are involved