Those who question the move insist that many times the follow-up services are NOT available, and that the new medications are frequently not accessible to these people because of expense. As many other medical patients do, they may begin to deny that the illness still exists, and discontinue their meds. On the other hand, the needed medications may not be available to them. Whatever the reason, their new gains vanish and they are re-hospitalized. There they stabilize, are released, and the whole cycle repeats.
Case workers add that their case loads are enormous.
Some clients need to be in residential care or group homes. Those facilities must be developed, staffed and maintained. All these things are essential for a community-based plan to succeed. But where the community is prepared, the cost is found to be less than maintaining huge centralized institutions which were needed half a century ago but not now, with new insight into psychiatric illness and modern treatment methods. The National Alliance for Mental Health is a group that has great influence on care of people with psychiatric illnesses.