[The evolution of a comprehensive community service system]

The evolution of psychiatric care in the United States is still strongly influenced by the consequences of deinstitutionalisation. In some cases the process has generated a sort of transinstitutionalisation: at present, there are more intermediate public structures than a few years ago, whereas small residential units, experimentally self-managed by chronic patients, are also being established. With regard to the State of Illinois, current efforts are focused on the reduction of the number of psychosocial disabilities and the setting up of a wider range of rehabilitative programs. A comprehensive community service, connecting short-term and prolonged-stay hospital wards with community-based facilities seems to represent the most promising combination.