Abstract
Considerable attention has focused on the recent decline in the numben of psychiatrists working in community mental health centers (1) and the fact that the role of psychiatrists in many CMHCs has changed from one of leadership to one of little authority (2). It has been reported that psychiatrists are very dissatisfied with their roles in CMHCs, partly because of their inability to provide adequate medical care for their patients (3). In addition, the impact of deinstitutionalization on the severely and chronically mentally ill has generated increasing concern about how to meet the major medical and psychiatric needs of patients in the community (4). Despite this concern, there are only a few reports of how individual CMHCs have attempted to meet the medical needs of their patients or have related to primary health care delivery systems (5-7). To the best of our knowledge, the nature of medical services within an entire community mental health system has not been described.
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