The patient care crisis in community mental health centers: a need for more psychiatric involvement.

The authors examine the role of psychiatrists in community mental health centers and suggest that extensive psychiatric involvement is needed to ensure proper patient care. Within the context of four basic clinical models--social, psychological, behavioral, and biomedical--they describe the psychiatrist's unique clinical skills in history taking, differential diagnosis, case formulation, use of psychopharmacologic agents, and provision of leadership in patient care. Five case reports illustrate instances in which psychiatric intervention corrected serious problems in diagnosis and treatment that otherwise would have resulted in inadequate care or harm to the patient.