In most countries, psychiatry is now practised in the community rather than in institutions, and where this change has yet be completed, it is generally recognized that it should take place. The change has done much more than transfer the locus of care; it has converted patients from passive recipients of care to active participants with individual needs and preferences. Psychiatrists are now involved in the planning, provision, and evaluation of services for whole communities, which may include members of ethnic minorities, homeless people, and refugees. Responsibility for a community has underlined the importance of the prevention as well as the treatment of mental disorder and of the role of agencies other than health services in both. Care in the community has also drawn attention to the many people with psychiatric disorder who are treated in primary care, and has led to new ways of working between psychiatrists and physicians. At the same time, psychiatrists have worked more in general hospitals, helping patients with both medical and psychiatric problems. Others have provided care for offenders.
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