Bridging individual, family and community care: a comprehensive treatment program for the chronic mentally ill

For about 25 years an integrated individual-family-community program for chronic mentally ill patients has been implemented in Israel, mostly in the kibbutz setting. The treatment model is based on a combined professional and paraprofessional therapeutic team that designs a structured community program in the following areas: individual and family therapies, life-skills training, medication management, and enhancing performance in work and social spheres and in physical and leisure-time activities. This study reports on the treatment of 124 psychiatric patients who have been followed-up for at least four years. Fifty percent of these chronically incapacitated patients achieved the goals of the community program and were found to be totally or greatly improved in terms of marked improvement of functioning and quality of life, resocialization, work stability and avoidance of rehospitalization. Fourteen percent of the patients were substantially improved, and 36% did not achieve the desired goal of satisfactory integration into community life. A case study that demonstrates the clinical application of the program is presented and the implications of the findings are discussed with respect to the community mental health service delivery system in Israel.