The challenge of chronic mental illness: a retrospective and prospective view

The challenge of chronic mental illness lies in developing effective service delivery systems that will preserve patients' functioning and limit their disability. The author uses a review of changes and excesses of the past 30 years--including deinstitutionalization, relocation of patients to nursing homes, the domination of psychodynamic concepts, and the naivety and partial successes of the community mental health movement--as a basis for outlining manageable ways to meet this challenge. Care for the chronic patient must be developed within a long-term rehabilitative context and with wiser use of available benefits and funds, including consolidation of funding sources. Mental health advocates should coordinate activities rather than compete with one another, and case management should be based on more sophisticated concepts and training.