Psychiatrie Sociale versus Psychiatrie Communautaire

The author briefly describes the historical factors in Europe and also in North America which have promoted the development of a type of psychiatry sometimes designated as ‘social psychiatry’ or more often ‘community psychiatry’. The term ‘community psychiatry’ can be misleading and its increasing use implies, in the mind of many, a value judgment by which a greater prestige is attached to such a category of psychiatric service, in contrast to the hospital psychiatric service. This is an unfortunate consequence; for this reason and others explained in this paper, the author advocates relinquishing the term ‘community psychiatry’ and replacing it with ‘social psychiatry’. Theoretical and practical considerations on the respective roles of the State and of the community in organizing and maintaining psychiatric services are discussed. The author reflects on a misconception often observed in North America, according to which a so-called community service becomes synonymous with a private service, i.e., not operated and not entirely financed by the Government. The role of the Government and more particularly of the various pressure groups which can influence decisionmaking on social issues, is presented as being of fundamental importance in social psychiatry. Furthermore this paper underlines certain dangers which stem from the current tendency to consider hospital treatment as being a last resort measure; e.g. the massive discharge of patients towards so-called community resources which is often accompanied by a deprivation of adequate care which the hospital milieu was providing to those patients. Finally, a fair distribution of personnel giving treatment throughout all the areas of a given country appears to be a basic prerequisite to any national program of social psychiatry.