Community treatment of the chronic patient: research overview

Abstract

The deinstitutionalization and community mental health movements have led to a proliferation of community treatment programs for the chronic psychiatric patient; yet there has been little rigorous research evaluating their efficacy. This paper reviews the controlled studies on community treatment and looks at the feasibility and effectiveness of alternatives to mental hospital programs, premature release studies, and a variety of community aftercare services. Findings consistently show that most patients usually admitted to hospitals can be treated in community alternatives. Furthermore, it appears that some kind of ongoing community treatment or aftercare program is essential in maintaining sustained community tenure. Functioning of patients in community programs is as good as that in in-hospital programs, and models stressing intensive training in community living skills have resulted in modest gains in psychosocial functioning. Much work remains to be done in isolating the critical variables in community treatment programs in order that they may be implemented in the most streamlined form.