ABSTRACT
There have been two overall trends in the development of mental health care since the Second World War: (1) a striking expansion in the scope of care, with more providers treating a greater variety of complaints in an increasingly diversified clientele; and (2) a shift away from the mental hospital as the principal setting for care, towards a mixed system including psychiatric units in general hospitals, outpatient clinics, day hospitals, and a variety of community-based settings.1 The expansion of care has been in many ways an unplanned development, although apart from depending on economic conditions, it has been shaped by insurance provisions and by new social welfare benefits. The trend is clearly visible in the growing number, and in the diversified employment patterns, of mental health professionals.2 Even more remarkable has been the growing number among those professionals who are not physicians, and who provide a considerable proportion of the total care, often in nonmedical settings.3 As the providers have diversified, so of course have the consumers; in particular, demand for treatment of the less serious varieties of psychological disorder or distress has grown enormously.
