Recovery From Schizophrenia: Psychiatry And Political Economy

Chapter 12Desegregating schizophreniaIt is easy to tell horror stories, and there are plenty in this book. It is harder tocome up with ways to alleviate the plight of the mentally ill in the Western world.How can we help people with schizophrenia re-enter today’s society and achievea genuine degree of social integration? In this chapter we will look at practicalanswers to this question.COMMUNITY SUPPORT SYSTEMSThe treatment programs of the Mental Health Center of Boulder County,Colorado will frequently be used as examples. They illustrate what is possiblegiven the usual level of community mental health funding 1 and a commitment toproviding decent care for the most seriously ill patients. The center has beensuccessful in keeping nearly everyone in Boulder County with serious mentalillness out of inadequate living situations such as homeless shelters, nursing homesand jail and establishing them in independent domestic settings in thecommunity. A summary of the location of mental health center clients withpsychotic illness in early 2002 is given in Table 12.1. The mental health center inBoulder, like a number of others across the United States, was designated a modelcommunity support system for severely disturbed patients by the US NationalInstitute of Mental Health in the 1970s and has continued to add new programssince then.The services and programs that may be offered by a community support systemrange from individual counseling through psychosocial rehabilitation andvocational services to family support and public education. Services may beoffered to patients in hospital, group homes, independent living or wherever theclient can be found, whether it be in jail or a shelter for the homeless. Thefunctions of such a system may be succinctly expressed by the followingcommandments. The treatment agency shall:• adopt total responsibility for the severely disabled client’s welfare, includinghelping the person acquire such material resources as food, shelter, clothingand medical care;