Fifty years of psychiatric services: 1940-1990.

Using data from the National Institute of Mental Health and the Census Bureau, the authors examine trends in the delivery of mental health services over the past 40 years as they relate to number and types of facilities, utilization of services, diagnosis, and maintenance expenditures. The data show that during this period access to psychiatric services has been broadened, and there has been increasing use of outpatient and community-based services. More recently there has been increasing reliance on the private sector to provide services, with the help of third-party reimbursement. In addition, the types of facilities have become more varied, providing a broader range of options for mental health care. The authors consider the future of mental health services in light of these trends.