Future changes in mental health care.

Abstract

A NUMBER of existing forces must be taken into account when attempts are made to predict changes in mental health practice in the coming years. They include the increasing demand for services from mental health, social welfare, and community agencies; the failure of current therapeutic approaches; changing public attitudes; and more sophisticated approaches to administration of mental health facilities. All of these forces, and perhaps many more, acting together over time will bring drastic changes in mental health care. The predicdons I make here are based partly on a realistic analysis and largely on wish-fulfilling dreams. The first force to be considered is the increasing demand for mental health services. The insufficient number of highly trained personnel, particularly psychiatrists, has already brought an evolution in staffing patterns of mental health programs. Both nonprofessionals and professionals from a wide variety of disciplines are carrying out many functions once considered the domain of a specific professional group. Role-blurring is so extensive that disciplines are becoming almost of secondary importance in staff recruitment, pushed aside by considerations such as personality, experience, color, and ethnic background. There is growing use of nonprofessional workers who have relatively brief training in specialized areas such as drug abuse, abortion counseling, and suicide prevention. The failure of traditional therapeutic approaches points up the clear necessity of finding more productive ways to care for the emotionally disturbed. The social disability resulting from prolonged institutionalization has become widely recognized and deplored.1 The inpatient therapeutic communities of the fifties and sixties have failed to