System Needs for the Rehabilitative Treatment of the Revolving Door Population

Abstract

The community mental health ideology is closely identified with deinstitutionalization and community psychology in its efforts to maintain as many people as possible in their natural environments. One frequently used means of evaluating the success of the community mental health movement is the examination of recidivism rats and average length of stay per patient admitted to psychiatric facilities. Examination of both U.S. and Canadian rehospitalization statistics has shown a population at risk of frequent rehospitalization. This “treatment resistant” group threatens the perceived effectiveness of the community mental health movement because of its impact on the recidivism measure. The revolving door population presents for service a multiplicity of problems that are of two basic varieties: psychiatric symptoms and social/vocational deficits. Descriptions and explanation of the services required to address these problems are presented. Issues of co-ordination, evaluation and system self-correction are discussed in relation to the seven service functions identified as necessary for improving the community tenure of this marginally functional population. Implementation issues that include key assumptions that must be adhered to by systems personnel, likely failure points in the planning of comprehensive mental health systems, and practicalities of manpower recruitment are discussed. Suggestions for the goals and strategies of the planning of comprehensive service systems for the revolving door population are presented.