Community Psychiatry at Harlem Hospital is both an approach and an institution. As an approach it guides the delivery system of the Department of Psychiatry, keeping the focus of that system trained on prevention and the twin goals of comprehensive treatment and continuity of care. As an institution it takes the form of the Division of Community Psychiatry, one of the six clinical divisions in the Department. The Division of Community Psychiatry was one of the first divisions formed in the Department of Psychiatry when the Affiliation Program between Columbia University and Harlem Hospital came into existence in 1962 under the directorship of Dr. Elizabeth Davis. Then, as now, its main I unction was the provision of mental health consultation and education to the Harlem community. Since its inception it has had three chiefs, Dr. Lonnie MacDonald, Dr. Sheldon Zimberg, and, the current chief, Dr. John Rosenberger. They all had postgraduate training in community psychiatry and were well versed in the fields of addiction and corrections.
Consultation and education in the Division has mainly taken the form of working with various kinds of human service agencies in the Harlem community. Guided by the concepts of CapIan, the division staff has utilized primarily case and program consultation in their work. More recently, however, under the impact of working with antipoverty agencies, some different approaches to providing consultation have had to be developed. Traditional forms of consultation have worked well with traditional agencies, such as the Department of Social Services and the Visiting Nurse Service, but the different styles and needs of anti-poverty programs have required a new methodology. One new method recently developed by the Division, called loint Project Development, involves the direct participation by Division staff in some project conceived by and run jointly with an anti-poverty agency. Currently the Division is involved in two such projects. One of these, the Harlem Probation Project, run jointly by the New York City Office of Probation and Harlem Teams for Self Help, under a federal LEAA Grant, has led to the local decentralization of probationary services in Harlem and the utilization of paraprofessionals in providing probationary services. The cither project, the Harlem Addiction and Rehabilitation Training Program, developed jointly with Skill Advancement, Inc. and the MalcolmKing College Extension Program under an NIMH Grant, is the only Harlembased program designed to provide extramural, formal, college-level training and education to addiction workers.
While the Division of Community Psychiatry has not had a formal mandate to provide direct services to patients, four programs of this type have been developed in the Division, three of which have subsequently been spun off. The first treatment program specifically for heroin addicts in the hospital was initiated in 1963 as an in-hospital detoxification program for addicted females. The Harlem Hospital Comprehensive Alcoholism Program, now run jointly by the Departments of Psychiatry and Medicine, was started as a research project by the Division to compare the results of a comprehensive socio-therapeutic approach with a pharmacological approach in the treatment of alcoholism. (Preliminary analysis of data indicates no significant differences between the two approaches, as has been reported elsewhere.) Another direct service program begun by the Division is a Geriatric Mental Health Program which has recently been funded as a separate clinical unit in the Adult Outpatient Clinic. The final direct service project is a hostel for the chronically mentally ill established in the local YMCA, developed cooperatively under the leadership of the Division by the New York City Department of Social Services, the YMCA and the various adult psychiatric services at Harlem Hospital.
Another major activity area for the Division is residency training. The Division runs a weekly seminar in Community Psychiatry for first-year residents, focusing on the historical development of community psychiatry and providing some basic information in such areas as epidemiology, forensic psychiatry, the concept of the community mental health center, etc. In his second year, each resident spends onehalt day per week providing consultation to a community agency under supervision. In the third year of the residency a six-month elective in community psychiatry is available. For the past two years the Division, along with the Assistant Director for Residency Training, has developed and run a nine-week seminar for entering firstyear residents entitled "Socio-cultural Factors in the Practice of Psychiatry at Harlem Hospital." This seminar is designed to help residents new to Harlem adapt to living and working in the Harlem community.
Finally the Division of Community Psychiatry, in line with its education function, is primarily responsible for public relations in the Department. In this regard the Mental Health Educator in the Division is the editor of the Department newspaper. She also is responsible for developing various materials describing the Department and its services to hand out to community residents during conferences, speaking engagements, community meetings, etc.
The staff of the Division is made up ol the following individuals: a fulltime psychiatrist who is the chief of the Division, two social workers, a mental health educator and a community liaison worker. In addition, the supervising social worker for adult services in the Department formerly worked exclusively in the Division and she continues to carry two agencies to which she provides consultation. All staff, in addition to their regular duties, are encouraged to participate in community activities according to their interests. Among the organizations in which staff members are involved are the following: the local community planning board, the community board of the hospital, the board of a local anti-poverty agency, and a number of community-based organizations attempting to develop programs in the area of crime prevention, adolescent mental health, services for the aged and welfare rights.