APA’s Psychiatric Services Has Filled Critical Niche for Seven Decades

The journal known today as Psychiatric Services began life in January 1950 as the APA Mental Hospital Service Bulletin. Within two years, the name was changed to Mental Hospitals. Then, in 1966 it became Hospital and Community Psychiatry until 1995, when it received its current name.

The shifts in name over time were not window dressing. They represented less a search for a brand name and more a reflection of the changing places and methods for delivering care to psychiatric patients.

The years surrounding the journal’s founding in 1950 were momentous for mental health care. In 1946, Congress had passed the first national Mental Health Act, which established the National Institute of Mental Health and led to more funding for research, training, and support for state mental health systems. Lithium was first used in 1948, and the first antipsychotic drug, chlorpromazine, was introduced in 1952. The year 1955 was the high watermark for the patient population of state mental hospitals.

The mental hospital may have been the primary locus of care in those early days for people with psychiatric illness, but that evolved over time with deinstitutionalization, the passage of the Mental Health Act of 1963, the inadequate movement to community care, advances in clinical treatment, and changes in payment systems.

The journal’s development is reflected in its editors. The first editor was Daniel Blain, M.D., then APA’s medical director, who managed those duties along with issuing a four-page monthly newsletter. Donald Hammersley, M.D., chief of professional services and then deputy medical director of APA, took over in 1971.

The first editor not on the APA staff was John Talbott, M.D., now a professor emeritus of psychiatry at the University of Maryland, who led the journal from 1981 to 2004.

“The feeling was that academic or private practice psychiatrists had the American Journal of Psychiatry and the Annual Meeting, but that in the public sector—and this included nurses and psychologists as well as psychiatrists—we had the Institute on Psychiatric Services, but there was still a need for another means of communication,” said Talbott in a recent interview. “The newsletter was a way of exchanging useful information that didn’t reach a journal level.”

Talbott, then at Cornell, was well prepared for the job. He had run a state hospital, had edited a quarterly for public hospitals in New York state, and served on the journal’s editorial board from 1978 to 1980.

“The change in the journal’s name over four decades reflected the reality for a changing field and also broadened its scope, covering care delivered anywhere from hospital to primary care,” said Talbott.

When Howard Goldman, M.D., a professor of psychiatry at the University of Maryland, became editor in 2004, it was the culmination of a long personal process. “This was the journal I first read when I was in training,” he said in an interview. In fact, Goldman, by chance, had written the lead article in Talbott’s first issue as editor.

Talbott worked hard to raise the journal’s academic standing without losing its connection to public psychiatry. His tenure coincided with an increase in interest in and funding for mental health services research. Goldman continued the efforts to increase the scientific rigor of the research articles in the journal but also sought to expand Talbott’s invitation for nonclinicians—like economists, sociologists, operations researchers, and others—to contribute their thinking.

“We got away from specialty settings and added the perspective of other social services, like housing and criminal justice,” said Goldman.

One notable feature of Psychiatric Services today is the dozen or so columns that appear in rotation in the course of each year. The columns, whose numbers and subjects have varied over the years, are not mere adjuncts but perform a key role within the journal, said Goldman. They are a legacy of its origins as a source of news about services. They also can be more topical and introduce new ideas without the formal constraints of the scientific reports.

“In the past, the journal focused on people with the most serious mental illnesses, but it shouldn’t restrict itself to any particular population,” said Psychiatric Services current editor, Lisa Dixon, M.D., M.P.H., a professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons and the New York State Psychiatric Institute. A focus on service delivery may seem narrow at first, she said, but that heading includes a broad range of issues—economic, social, legal, policy, and others.

“I’m a health services researcher, so I’m interested in all things that influence the world of care and how people do or don’t participate in that care,” said Dixon in an interview. “I’m glad that the locus and methods of care have gone beyond the institution, not only to the community but now to the online world. The journal needs to keep pace with the changes in the context and methods of service delivery.”

Understanding new pathways to knowledge is an important task. To that end, Dixon has expanded the journal’s presence online and in social media. For example, the journal regularly posts podcasts under the name “From Pages to Practice” and recently launched “Editor’s Choice,” which is a curated collection of articles focused on a specific area with links to content in Psychiatric Services.

“That’s where people access information,” she said. “Our goal now is to continue publishing great research, maintain rigor, and enhance relevance, while taking that content and presenting it in an engaging manner. We need to create products that conform to the way people learn and access information today.”

If Dixon is right, Psychiatric Services’ name may be secure for the future, but its mission is likely to continue adapting to the times and its diverse readership. ■