The chronically mentally ill: planning a future

The plight of the chronically mentally ill in contemporary society is explored. Appropriate treatment strategies identified require organizational changes at both local and provincial levels, and altered management philosophies. The criteria used in major studies to define the study population are identified and epidemiological data provided to illustrate the numbers and disposition of sufferers of "Prolonged Functional Disabilities caused by or aggravated by Severe Mental Disorder." Operational and research data from a regional psychiatric research service confirm that many patients formerly considered chronically institutionalized can be successfully discharged when goal-oriented multidisciplinary methods are introduced. External inhibiting factors are identified which society must address. Psychiatry must embrace and develop the new philosophies. Rational planning based upon patient need will require changes in the present vertical hierarchical structure of health care organization. Some elements of a strategic planning model are identified.