The June 1985 issue of the Archives of General Psychiatry devotes a major share of its space to six papers,1-6 each of which bears on fundamental questions of cost and of benefit in the provision of psychiatric services. Five years ago, the Archives would probably not have published more than six such articles in an entire year. But the new fiscal regulatory environment dominating current thought about the provision of medical services is also fundamentally altering the manner in which services are and will in the future be provided.
It may be useful to recall briefly how the present situation came to pass. To considerably simplify a complex history, until the end of World War II, American psychiatry was overwhelmingly (although not exclusively) a public-sector-state-hospital dominated field. From 1945 until the early 1960s, psychiatry experienced a period dominated by specialization (and subspecialization) of practitioners and by an accelerated formulation