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There is a core of services whose specific content varies from place to place that still appears to belong to the state mental hospital.

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The authors discuss what can be learned from our experience with deinstitutionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services. The greatest problems have been in creating adequate and accessible community resources. Where community services have been available and comprehensive, most persons with severe mental illness have significantly benefited. On the other hand, there have been unintended consequences of deinstitutionalization-a new generation of uninstitutionalized persons who have severe mental illness, who are homeless, or who have been criminalized and who present significant challenges to service systems. Among the lessons learned from deinstitutionalization are that successful deinstitutionalization involves more than simply changing the locus of care; that service planning must be tailored to the needs of each individual; that hospital care must be available for those who need it; that services must be culturally relevant; that severely mentally ill persons must be involved in their service planning; that service systems must not be restricted by preconceived ideology; and that continuity of care must be achieved.

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OBJECTIVE: To examine the relationship between psychosocial rehabilitation and psychiatry with particular emphasis upon treatment of people who suffer from schizophrenia. METHOD: Current literature is examined in an effort to identify prevailing premises and myths held by each discipline as it relates to the other. RESULTS: A working definition of psychosocial rehabilitation is proposed, and nine interrelated concepts that constitute the belief system of that discipline are identified. CONCLUSION: Rehabilitation's biopsychosocial perspective provides a strong basis for joint enterprise with psychiatry in the care of people with schizophrenia. However, members of both disciplines must pursue active measures in order to effect co-operative treatment interventions.

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There is a core of services whose specific content varies from place to place that still appears to belong to the state mental hospital.

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OBJECTIVES: This analytical review is intended to update the author's earlier writings on the position of the state mental hospital within the spectrum of services for long-term mental patients and to provide a perspective for the next generation of service planners. METHODS: Findings and commentary are organized around four major questions. First, what is the prevailing view of state mental hospitals today, and how does it compare with the view that existed in the first half of this century? Second, what individuals tend to be served in state mental hospitals today? Third, what has been the fate of mentally ill persons who are no longer served in state mental hospitals? Fourth, what is an appropriate role for the state mental hospital in today's uncertain and rapidly changing systems of care? RESULTS AND CONCLUSIONS: Individual state mental hospitals vary in the composition of their resident populations, the content of their services, and the overall quality of their care. Although they have been superseded by community-based service structures in some places, they continue in general, as the result of their multifunctionality, to occupy a critical place in systems of care. Renewed efforts to integrate them as full partners within those systems must be undertaken.

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OBJECTIVES: This analytical review is intended to update the author's earlier writings on the position of the state mental hospital within the spectrum of services for long-term mental patients and to provide perspective for the next generation of service planners. METHODS: Findings and commentary are organized around four major questions. First, what is the prevailing view of state mental hospitals today, and how does it compare with the view that existed in the first half of this century? Second, what individuals tend to be served in state mental hospitals today? Third, what has been the fate of mentally ill persons who are no longer served in state mental hospitals? Fourth, what is an appropriate role for the state mental hospital in today's uncertain and rapidly changing systems of care? Source material consists of periodical articles suggested in MEDLINE searches, plus newspaper reports, recent books on mental health service systems, and a variety of writings found in the "fugitive" literature generally not indexed in traditional archives. RESULTS AND CONCLUSIONS: Individual state mental hospitals vary in the composition of their resident populations, the content of their services, and the overall quality of their care. Although they have been superseded by community-based service structures in some places, they continue in general, as the result of their multifunctionality, to occupy a critical place in systems of care. Renewed efforts to integrate them as full partners within those systems must be undertaken.

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OBJECTIVES: 1. To examine the conceptual underpinnings of psychosocial rehabilitation and underscore its essential relationship to the practice of psychiatry. 2. To explore and dispel some misunderstandings and myths that practitioners in each field sometimes carry about the other. METHOD: Literature review and observation. RESULTS: Psychiatry and psychosocial rehabilitation's shared emphasis on the biopsychosocial nature of mental illness forms a compelling basis for cooperative enterprise. CONCLUSIONS: Mentally ill persons are best served when the disciplines of psychiatry and psychosocial rehabilitation come together in a common cause.

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