The future of psychiatry: communities in action.

Psychiatry and psychotherapy are in the midst of a turbulent time. The increasing control of cost-cutting health maintenance organizations over health care delivery has resulted in a monumental shift in the field. Primary care providers prefer to treat psychiatric disorders with medication instead of psychotherapy. Consequently, psychiatrists and related mental health professionals must find new ways to offer treatment. The author suggests that this transition period offers a tremendous opportunity for psychiatrists and other therapists to look beyond the standard doctor-patient context and reach into the patient's community, involving other social organizations to form a network of total care. To understand how the mental health field reached this stage and to understand what lies ahead, it is essential to look to the past.