Five years' experience with the use of drugs and psychotherapy in a community aftercare clinic.

Abstract

SINCE ataractic drugs became available, chronic schizophrenic patients can, for the first time, be maintained in the community functioning on a satisfactory occupational and general social level. Aftercare of such patients returned to the community, after a more or less prolonged hospital stay, can reduce the return rate of such patients very considerably (10 per cent and less). This report deals with several unselected groups of 100 patients each who were kept under continuous close supervision for five full years. They came to the Research Unit of the Manhattan After-Care Clinic in response to a special request: The directors of several New York State hospitals in the metropolitan area had been asked to advise patients to report to the clinic on the day immediately following their release from the hospital. These patients were seen at least once weekly during the first two or three months and, when necessary, moreoften.' The time interval between clinic visits was lengthened later in the study. At the same time close contact was maintained with the family or friends whereever possible. If a patient failed a clinic appointment and did not contact the clinic within 24 hours, the patient was reached either by telephone or by letter in order to arrange another appointment. If he failed his second appointment, a home visit was made immediately to ascertain the reasons for these omissions to come to clinic. Home visits were made either by the psychiatrist, social worker, nurse, or occupational therapist. Beginning with the initial interview the entire research staff tried to impress on each individual that patient and staff are one team, with one common goal, namely to do everything possible to facilitate rehabilitation of the patient and his readjustment in the community. Relatives and friends were instructed and advised to bring any problem to the staff's immediate attention. In the course of the years it became more and more apparent that practically all chronic patients, that is, those patients who were hospitalized continously for a prolonged time, or those who had several hospital admissions, required maintenance pharmacotherapy for several months, or even years, and possibly would have to be maintained on such therapy indefinitely. It was noted in a number of cases that patients who had adjusted well under maintenance pharmacotherapy for about four years or more in the community, relapsed rapidly when drugs were discontinued. Reinstitution of drug therapy brought the overt psychotic symptoms under control. Cases of a more acute nature sometimes also required maintenance therapy, particularly at times when patients had to face life situations exerting considerable stress.2 Unless such therapy was instituted, these patients were unable to live through such periods without showing reactivation of symptoms. The