Systemic Community Psychiatry

Abstract

On different occasions I have written about the integration of systemic approaches in community mental health. They have included experiences of constructive therapies in day treatment and outpatient settings, a thorough analysis of the state of the mental health system in community settings, and a risk-reduction program for multiproblem families. Having elaborated on attempts at impacting the delivery of mental health services with the introduction of systemic practices, I want to introduce a preliminary account of my work as a systemically oriented community psychiatrist, based on my experience since my arrival in the U.S. in 1989 at the beginning of the managed care era. In the current mental health system, credentials are destiny. As psychiatrists (physicians), our work in community mental health settings is necessarily restricted to providing psychiatric services, which has come to mean so-called "medication management." Psychotherapy is generally provided by other professionals (social workers, psychologists, nurses, and educational specialists) to those same clients whose purported "chemical imbalances" (a term increasingly in use by mental health practitioners in the current "decade of the brain"). Still, well paid within the hierarchy of the mental health services system, psychiatrists saw their expertise increasingly constrained by a rather limited biological view and their practice restricted to serving as "neurotransmitter technicians." The new generation of psychiatrists, trained only on this simplistic biological view of emotional problems, does not have adequate knowledge about psychotherapy; training and expertise in the social aspects of mental illness has all but disappeared for them. (PsycINFO Database Record (c) 2016 APA, all rights reserved)