PEDIATRICS Vol. 46 No. 5 November 1970, pp. 807-809
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UTILIZATION OF A PEDIATRICIAN IN A MENTAL HEALTH CLINIC

II. An Affluent Community

William E. Stone M.D.1

1 Department of Psychiatry, Harvard Medical School, Boston, and Director, Newton Mental Health Center, Newtonville, Massachusetts

The field of psychiatry, and certainly the subspecialty of child psychiatry, is currently involved in an identity crisis which has particular relevance to the relationship between the pediatrician and the psychiatrist in the delivery of mental health services to children. This crisis is related to the move from patient-oriented psychiatric treatment to the newer methods of community mental health. A good community mental health program is founded on the knowledge and skills learned from careful work with individual patients, but the techniques and goals of treatment require modification. While individual psychotherapy is still an essential part of patient care, it is frequently impractical in the light of the demands and needs of our current culture. In the community mental health center which I am serving, we are currently involved in a major reassessment of our techniques in order to meet the needs of the community rather than the demands of a small group.

Ours is a relatively affluent community, generally considered to be sophisticated, well-educated, and knowledgeable about psychiatry. An easy pitfall in developing a mental health center would be to assume that this is an accurate picture of the entire community and base the whole program on the model of private psychiatric care. However, the city has its pockets of poverty and has large numbers of people who would not respond to insight therapy if it were available to them.

Psychiatrists have been, until very recently, poorly trained for work in the community. Their work has been principally in mental hospitals and in outpatient clinics that offered treatment to a very select group of patients.