The organization of psychiatric services

Abstract 

Psychiatric services have evolved continuously since their inception. This evolution has accelerated recently, driven by various factors – increased understanding of psychiatric disorders and their treatment, the introduction of a welfare state, changes in societal attitudes, the move away from institutional care. With the move away from large institutions, systems of care have become increasingly complex, often with a number of different services operating in any one geographical area. Despite marked differences between services, all are characterized by multidisciplinary working, this is probably most evident in the community mental health team (CMHT). Increasingly, services have specialized, and the UK National Service Framework introduced the so-called ‘functional teams’ – assertive outreach, crisis resolution, and early intervention. Provision of these services does vary according to local need and resource. Different nations have developed services in different ways, and some noteworthy examples are presented. Finally, we briefly outline the key current issues in the organization of services, as we understand them.

Keywords: community mental health teams, community psychiatry, crisis resolution, deinstitutionalization, multidisciplinary working, service delivery