COMMUNITY PLANNING AS A SUPPORT TO TREATMENT

To recapitulate, the necessity for adequate planning is justified not only by current scientific knowledge that indicates its validity, but also by the practical necessity for making the most efficient use of any and all available resources.

When we total our current scientific knowledge we hear that "much of the disability in mental illness is superimposed by social and treatment mechanisms and is preventable and reversible" (9). A review of financing (tax funds supply probably 90% of the budgets for services) tells us that "discussion focuses on assertions that the states have reached their taxing limits"(10). When we examine our personnel picture and the training and recruitment prospects (11) we find that it will take all our ingenuity to stand still. These are sobering and responsibly drawn conclusions. They indicate that we cannot expect more of what we have, without limit. We cannot assume that our currently uncoordinated efforts are making maximum use of existing facilities. We must continue to discover and make creative use of related facilities which can contribute to the solutions of our problems.

This assumes that we have defined our problems in both qualitative and quantitative terms; that we have an appreciation of our resources and that the means of communication exists to consider getting the two together (12). This is a large assumption. Nevertheless it is the only base on which planning can define and consider the issues. The alternative is to continue our buckshot approach of more of the same, in the hope that if some is good, a lot is better.

Planning can start with the individual practitioner out of whatever professional discipline he represents. He is in a position to appreciate the needs evidenced in the individual case. Through his relationship with his colleagues in membership organizations or through hospital and agency structures these individual needs become cumulative and are communicated. (We have herein noted how this chain reaction can move from the National scene to the clinical decision.) As the needs of individuals become clear it is possible to design and implement services to meet these needs. From private practice case planning up the line to broad program planning, reality factors must be identified and met. The reality variables may well be decisive in determining whether or not our technical skills will have an opportunity to deal with personality pathology or its manifestations!