Psychiatric manpower for state mental hospitals. A continuing dilemma.

A shortage of psychiatrists continues to exist in state mental hospitals (SMHs), and Public Law 94-484 is likely to aggravate this problem. A telephone survey was done of 50 state departments of mental health to collect data about (1) the number and kinds of SMHs in each state;(2) the percentage of psychiatrists in SMHs who are foreign medical graduates; and (3) strategies for attractiing psychiatrists to SMHs. States with SMH residency training programs employed significantly more psychiatrists and paid significantly lower salaries than did states without these programs. Nine states reported no or few problems obtaining psychiatric staff. These nine states employed more psychiatrists and had a smaller proportion of foreign medical graduates than the remaining 41; salaries were similar. Sets of strategies for obtaining psychiatrists were identified for all 50 states. The strategies of competitive salaries, university affillation, and incorporating the SMH into an interdependent network of quality mental health care delivery systems are examined in detail.