In a rash moment of bonhomie, having offered to one of the editors to write a personal view of psychiatry in the USA today, and with his encouragement to proceed, I find myself a long time later reflecting as to why the task seems to have been so daunting. Interpretations regarding my DSM-III-Axis II disorder apart, the numbers involved perhaps provide some of the reasons. There are 38,276 psychiatrists in this country, mostly paying dues ($300.00 per year) to the American Psychiatric Association, which has 76 district branches across the country, with between a few dozen and a few thousand members each; $428 billion spent on total personal health care in 1988, approximately two-thirds of which was covered by Federal Government programmes, of which $351 million went to the mental health sector; 150,000 patients treated for longer than one year in the long-term care psychiatric hospitals in this postdeinstitutionalisation era; and 6.5 million persons resident in nursing homes (at an estimated cost of $46 billion) of whom more than 50% are estimated to suffer from Alzheimer's disease. From such an array it is difficult to distill the essentials with much confidence as to their reliability or significance. What follows is therefore selective and impressionistic.
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