Social breakdown syndrome: environmental and host factors associated with chronicity.

Abstract

Eight years ago APHA Program Area Committee on Mental Health stated:' There is one type of mental malfunctioning which occurs in many different chronic mental disorders, particularly schizophrenia, mental retardation, and various organic psychoses. (See Table I.) It is responsible for a very large part of institutionalized mentally disordered; it is responsible for much of other forms of extreme social disability seen in these illnesses. This form of mental reaction in presence of mental disorders is largely a socially determined reaction pattern which committee believes can be identified as a major target for community mental health programs today. It is called the Social Breakdown Syndrome. The Program Area Committee had indicated that acute episodes of SBS were very common and that chronic, long-term episodes were major preventable cause of severe disability. Our research group has developed ascertainment techniques to locate cases of severe Social Breakdown Syndrome by determining a set of some 22 objective facts regarding a person's functioning during a particular week.2 Around 1960 when these Program Area Committee statements were being written, we ascertained that annual incidence of chronic SBS (over 1 year in duration) was about 24 per 100,000 in ages 16-64 in Dutchess County, N.Y. Following a reorganization of delivery of psychiatric services for residents of that county-a reorganization designed to prevent chronic forms of SBS-the annual incidence dropped to about 12 per 100,000.3 This is a major improvement, because recovery rates from SBS episodes over one year in duration are very low. Only about half of these episodes will terminate in next five years.4 The handicap is severe, disability almost total. But a remaining incidence of 12 per 100,000 is not trivial-it is higher than suicide rate. What can be done to still further reduce annual incidence of chronic SBS? We first delineated personal factors which could identify a group of new SBS cases at high risk of becoming chronic. We looked at factors known Ernest M. Gruenberg, M.D., Dr.P.H.; Danielle M. Turns, M.D.; Steven P. Segal, M.S.W.; and Murray Solomon, M.S.