Urban America and the Planning of Mental Health Services

President Kennedy's legislation on community mental health centres has encouraged much detailed planning for comprehensive mental health programmes throughout the United States. Urban areas have special features in this respect, due to the density of population, the reduction of family privacy, the instability of social norms, and the juxtaposition of privilege and deprivation. The problem is to allocate resources not only to promote the general health and welfare of the community, but also to prevent and treat mental disorder and to rehabilitate the mentally disabled. What part should the psychiatrist play in this; has he the knowledge and training to plan on the scale that is required, or will he limit himself to clinical goals, ignoring the wider context of cultural and social conditions in which community mental health is fixed? This book poses problems which must arise in any serious planning for mental health services in urban areas. The main part comprises four papers by distinguished American sociologists and psychologists, who stress the need to consider sociological factors, and discuss the interaction between social and psychological maladjustment, and between the individual and his environment. In urban surroundings, the complexity of life is such that mental health services cannot be developed on clinical lines alone; planning should take account of social processes, and should utilise the informal as well as the professional resources of the community. These views are then discussed by psychiatrists, with emphasis on the practical considerations which must be met. Comments range from the difficulties of integrating staff and of ensuring adequate training in administration, to the need for preserving the psychiatrist's basic function as a clinician.