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The influence of social and economic forces on the placement and treatment of the chronically mentally ill is traced historically. This review suggests that minorities and the poor, who have in the past suffered the worst institutional care, will be most at risk in the community during the present era of cutbacks in social services. Deinstitutionalization, in making claims on resources that the larger community is reluctant to grant, is seen as jeopardizing needed incremental reforms.

The mental health program we are developing at the Yale School of Public Health has as its basic element a broad introduction to the concepts and principles of public health and mental health administration and is rooted in concern for community well-being. It is our belief that this combination of public health — mental health training will produce administrators for mental health, psychiatric and human resource agencies who will be able to design, implement, manage, and evaluate programs that improve mental health and help communities evaluate and structure the human services they need.

A sensitivity exercise with a combined Tavistock and T-group approach was led by mental health professionals for black city residents and the local police force. Many of the usual group dynamics were observed, including greater understanding of each other by most participants and the lessening of stereotypes. But powerful and militant factions in and out of the exercise used it to confirm a much-wanted temporary cease-fire rather than to bring about an end to their “war”. The theoretically-derived focus on boundary maintenance proved impossible to sustain in the group exercise, which could not be walled-off from the reality of a socially explosive local situation. This reality negated the attempt to bring about peaceful change, the unspoken agenda of the professionals and most of the others involved in the program. The exercise demonstrated again the need for a firm contract and for mental health professionals to be clear about their roles and motives when they serve as consultants in social conflicts situations.