Title: Community Adjustment of Chronic Psychiatric Patients
Description: This study examined the chronic psychiatric patients who were referred to Fountain House for psychosocial rehabilitation. Differences between the dropouts vs. the non-dropouts were tested. Applying a longitudinal design and using discriminant analysis, it was found that 70% of patients dropout over a period of six months; and that patients' personal characteristics as well as service variables are predictors of dropout and community adjustment. Although issues of collecting follow-up data on the dropouts were inherent, it was possible to identify patterns of adjustment for the non-dropouts. It was found that patients who stay longer in a rehabilitation setting, attend therapy, and comply with medication had better adjustment levels than others. This led to the conclusion that comprehensive long-term treatment is more effective than other single specialized model of treatment. Theories of milieu therapy, ego psychology, and empirical research pertaining to adjustment and dropout provided a rationale for developing this study, its conclusions, and its recommendations.

One recommendation to emerge from this study is that deinstitutionalization should be perceived as a step in the rehabilitation process rather than as a goal by itself. This study concludes that it is possible for chronic psychiatric patients to adjust to the community, but only if all elements of the system work as a complementary unit in which inpatient and aftercare facilities are integrated around the goals of rehabilitation and independent living. The application of milieu therapy based upon sound social work philosophy, research, and methods is essential for the promotion of the adjustment process and reduction of the dropout rate in aftercare facilities. Continuation of research and commitment for long-term, comprehensive treatment will meet the scientific and clinical challenges for dealing with those patients who are "difficult to reach." A second recommendation is that in addition to the usual concern with patient adjustment to services, there is a need to be concerned with the adjustment of services to patients.
Subjects: Psychotherapy patients, Community mental health services, Utilization