Toward increased psychiatric presence in community mental health centers.

The presence of psychiatrists in community mental health centers has diminished in recent years, especially in centers that are non-hospital-based and that are located in rural or disadvantaged urban settings. The decrease in psychiatric leadership in the centers is particularly notable. Factors contributing to the trend include lower salaries than in the private sector, a decrease in the number of patients with severe mental disorders coming to the centers, and the impact of a decrease in specialized training programs in community psychiatry. The authors suggest several incentives to increase psychiatric presence in the centers, including developing staffing standards as a condition of funding, giving psychiatrists time to do research and evaluation and to teach, and increasing the medical involvement of centers through links with general hospitals, private psychiatric hospitals, and medical schools.