Improving the Care of Patients with Chronic Mental Illness

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Abstract
THE organization of community care for patients with the most severe chronic mental illnesses is seriously deficient. Most of these patients depend exclusively on underfinanced, fragmented, and often inaccessible public services. The difficulties of providing adequate medical and psychiatric services are compounded by homelessness, abuse of alcohol and drugs, and large gaps in the continuum of services necessary to meet the profound needs of these people. Patients lost to the system are commonly found in shelters or jails or on the streets.Before 1955, when deinstitutionalization began, serious chronic mental illness was treated in public mental hospitals that had responsibility . . .