[Therapeutic communities for after-care of adolescent psychiatric inpatients]

The study reports experiences with two therapeutic apartments (12 residents) accommodating 30 young adults over a 5-year period. For this age group this kind of aftercare poses special problems: Contrary to previous evidence, patients suffering from psychotic or borderline disorders achieved a much lower level of autonomy than those with neurotic or psychosomatic disturbances and also did significantly worse regarding vocational integration and social contacts. Social contact behavior outside the group was the strongest predictor of the level of autonomy achieved. As the rehospitalization rate was high (50% of all residents), no economizing on inpatient capacities could be expected from this program. However, improvements in the number of staff and in the program itself did lead to a significant decrease in the length of rehospitalizations. Program-related factors that may increase the vulnerability of young people with psychosis are discussed in the context of the general state of psychiatric care.