The rehabilitation of the chronic psychiatric patient: Beyond the hospital-based token economy system

Abstract

Token economy programmes have offered a promise in the rehabilitation and community resettlement of the chronic psychiatric patient. However, most studies have concentrated on the behavioural gains while the patient is still in hospital with little or no follow-up on the subsequent community adjustment. This paper describes a comparative evaluative study between a token economy programme and a generic programme for chronic psychiatric patients. Social interpersonal parameters and follow-up discharge and readmission rates are given for the patients of the two programmes. The findings of this study indicate that neither programme by itself is effective in the rehabilitation of the chronic psychiatric patient as reflected in the discharge rates, maintenance of patients in the community and readmission rates. It is suggested that behavioural technology must be integrated with community psychiatry concepts and practice if adjustments to and stability in community life is to be achieved. Token economy programmes must extend into a structured and supportive posthospital community environment, and utilize community resources to maintain and further behavioural gains.