Relation of Psychiatry to Public Health *

An understanding of the social fabric of a community or State is essential for the development of constructive services in public health as well as in psychiatry. The aim herein is to define public health and mental hygiene, emphasizing the key position of the private physician, to discuss interrelationships of problems and services, and to mention some objectives yet to be achieved. No problem of public health is more important and yet more difficult of solution than that which relates to psychiatry and mental hygiene. The handicap due to mental and emotional maladjustments, in the average family, is probably as great as the burden of all other physical diseases and disabilities combined. Pratt emphasizes that the extent of the mental disease problem is seldom realized, although it can be said with confidence to be greater than that of any other malady known to man. "More patients occupy beds in hospitals for mental disease than are occupied by patients suffering from all other kinds of human sickness combined."t While the actual increase in the frequency of mental disease is small, the institutional problem continues to grow, because patients live longer than formerly, and because they enter hospitals faster than they leave, notwithstanding continued progress in treatment and cure. At the present time one out of every 259 persons in the United States is a patient in a mental institution. This figure does not take into account those thousands whose condition does not progress to the stage requiring institutional care. But we have good reason to believe that with respect to the less acute types of mental and emotional disorder a similar ratio holds as for the more acute and chronic conditions; and it seems probable that the total burden of