Abstract
The new organization and structure of the comprehensive mental health services in the Chicopee-Holyoke-area of Massachusetts, USA, are described. The services, which until 1975 were mostly located to a mental hospital, were rather bad. Patients and their relatives appealed to the court, which decided that the State of Massachusetts had to develop alternative services within the local communities. These services should take care of all kinds of patients, also “the most disturbed”. Today five types of services exist in the communities in addition to the mental hospital ward. These are: 1. residential services, 2. case management. 3. crisis units, 4. vocational services, 5. day care centre with an out-patient-clinic. A certain therapeutic mode “Social Competency Model” originally developed by the israeli psychologist M. Spivak has been successfully applied in the work with the most deviantly behaving patients. The hospital ward has been reduced to one tenth of its size in 1975. “The revolving patients” to th...
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