Public psychiatry refers to the delivery of mental health services to populations relying on public assistance. These groups can have specific needs in common that may not occur in other populations, such as lack of access to stable housing that makes it hard to adhere to a treatment plan. This field is also sometimes known as community mental health, in a reference to the fact that it is delivered directly in needy communities with assistance through public funding and support from charitable organizations. A network of public hospitals, clinics, and related services provide coverage to communities in need of mental health care.
Practitioners of public psychiatry study some of the intersecting needs of the populations they work with. They tend to be involved primarily in low-income communities of people who lack insurance and cannot afford private care. Such communities can include large numbers of ethnic minorities, homeless people, and people with comorbidities like serious illnesses and disabilities. Mental health needs can include severe mental illnesses like schizophrenia and bipolar disorder, along with drug addiction, situational depression, and anxiety.
Nurses, physicians, technicians, and orderlies work in public psychiatry in a variety of settings. They may provide inpatient and outpatient services to people voluntarily seeking treatment as well as people who have been placed under mandatory commitment or ordered to attend a program by the court. Treatment options may involve psychotherapy, medication management, group therapy, and connection with services to help patients stabilize their lives. Homeless patients, for example, might benefit from assisted housing to establish a routine to help them manage their mental illnesses and break the cycles that may lead to homelessness.
Management of patients in public psychiatry can involve cooperation with law enforcement and the courts, along with some unique ethical issues. Practitioners may need to balance the needs of the patient with the safety of the public, and deal with situations that may be frustrating. Patients may, for example, be in and out of treatment because they have difficulty maintaining a schedule, which can result in constant setbacks and relapses. Those with medical problems may need to see doctors for treatment to address those as well.
Working in public sector medicine can also include connecting patients with social workers and other services that may help them. Public psychiatry looks not just at specific mental health problems, but at needs of individuals interacting with the system who may need assistance. A patient may respond well to medication, for instance, but this is not helpful if other life needs aren’t met.