Psychiatric rehabilitation: key issues and future policy.

Medical practitioners have long recognized the critical importance of treating the consequences of physical illness as well as the illness itself. This concept did not take hold in the mental health arena until decades later, when the deinstitutionalization movement gained momentum, and increased numbers of persons with severe psychiatric disabilities changed residence from the back ward to the back street to, in many cases, the main street. With increasing visibility, the functional limitations of some of these persons quickly became apparent; in 1977 the National Institute of Mental Health (NIMH) launched the Community Support Program (CSP). The CSP was designed as a pilot federal/ state collaboration to explore strategies for delivering community-based services, including rehabilitation, to persons with severe psychiatric disabilities. National data on the persons initially served by the CSP illustrate the extreme functional limitations of this group. For example, median yearly income was $3,900; 50 percent received Social Security benefits; approximately 10 percent were competitively employed, and only 9 percent of the unemployed were actively searching for work; 88 percent were not married; and 71 percent rarely or never engaged in recreational activities with others. A more recent survey of CSP clients found a similar level of disability. A national survey of families of persons with mental illness also attests to the functional incapacities of this population. Families reported that only about 5 percent of their family members with psychiatric disabilities were employed full time, even though 92 percent had a high school education and 60 percent either had post–high school training or had attended college. In interviews of ninety-nine long-term patients of a community mental health center,