Psychosocial Rehabilitation Centers: Old Wine in a New Bottle

Abstract

The President’s Commission on Mental Health in the Report to the President in 1978, 17 years after the landmark report of the Joint Commission on Mental Illness and Health in 1961 to President Kennedy, reaffirmed with the hindsight of experience the need for correction of the deficiencies in deinstitutionalization and in community-based services for the chronically mentally ill population as a national priority (1). Though much progress is noted as having taken place since the first report, continued neglect of this population in the establishment of services is acknowledged as a recalcitrant problem bedeviling the country. The fact that this problem was a primary motivating factor for the first study only underscored the need, problem and failure. Detailed specifications of these deficiencies were amply documented in the 1976 report of the Senate Subcommittee on Long-Term Care (2) and the 1977 GAO Report to Congress (3). At the same time, the National Institute of Mental Health began to respond to this widespread criticism by a somewhat belated, agonized reappraisal of the role of community mental health centers. These considerations and resulting recommendations constituted much of the material which finally entered into the report of the Commission’s special, if less well-known, Task Panels on Community Support Systems and Deinstitutionalization, Rehabilitation, and Long-Term Care. Though these reports now provide a comprehensive and far-reaching reevaluation of this problem, high priority was given to redefining concepts and methodology for new social approaches for effective implementation. A review of the background may provide insight into some original oversights and, concurrently, a better perspective for a redirection of effort.