From state hospital to community psychiatry: Problems in two kinds of communities.

A division of a decentralized state hospital has experienced a 75% drop in census since practicing community psychiatry. Soon, it is anticipated that two comprehensive mental health centers will develop in the area it serves and that the division will "go out of business." In working with the "natural community" and the "therapeutic community," recurrent problems have been noted. Examples are offered in the areas of communication, working toward a community mental health center, deciding who should come to the hospital, and in the particular problems of the therapeutic community, including the problems of change, hospital size, and training.