Training implications of community-oriented psychiatry

Over the past 20–30 years psychiatry has gradually moved from predominantly hospital-based care to care in the community. Community psychiatry embraces a variety of definitions: it may describe the practice setting, the population served or the philosophy of illness and treatment (Johnston et al, 1995). In discussing the training implications of this shift towards community models of psychiatric care, we will not consider a separate discipline of ‘adult community psychiatry’. We believe that nearly all psychiatric specialities now involve substantial elements of work outside the hospital, and we therefore contend that the new skills, knowledge and attitudes required to meet the challenge of providing both hospitaland community-based care are pertinent to all trainees. Furthermore, the development of these are essential if the consultant of the future is to provide the safe, effective and sustainable service to those with complex mental health needs detailed in the recent National Service Framework (NSF) for Mental Health (Department of Health, 1999). We will also not attempt specifically to assess the merits of the move to community psychiatry, which may be subject to a separate debate. This article is based on general discussions by the Collegiate Trainees Committee of the Royal College of Psychiatrists and specific ideas generated within the working party. Literature was identified by searching the Medline and Psychlit databases using the keywords TRAINING and COMMUNITY PSYCHIATRY. Feedback on an early draft was obtained from the General Adult and Community Faculty Executive Committee. We hope that this article will stimulate discussion within training schemes and assist educational supervisors to review the training needs of trainees and identify potential areas for change.