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Using the team concept to change a psychoanalytically oriented therapeutic community.

When the Massachusetts Mental Health Center took responsibility for a geographic catchment area and began admitting a larger and more diversified group of patients, staff members had to re-examine their reliance on the psychoanalytically oriented therapeutic community. The authors describe how staff on one of the inpatient services formed multidisciplinary treatment teams to replace a physician-dominated structure, began using the hospital more flexibly, and involved themselves in the patient's external community. During the first year the census decreased by 23 percent, and the length of stay by about 30 days.