Evaluation of the clinical services of a regional mental health center.

A large midwest community-oriented regional mental health center reports a detailed methodology for evaluating the outcome effectiveness of clinical care for seriously disturbed mental patients. A controlled study of a 10% systematic sample of all public patients from a 10-county area compares the results obtained by traditional state hospitals with those of a new regional mental health center. The cohorts were followed for 3 full years. Outcomes were assessed in terms of social competence and economic cost to the patients and society. Although increased funds and staffing clearly improved the level of humanitarian care in all public institutions, no objective evidence was found that the community-oriented approach was superior in decreasing disability due to serious mental disorder. The study corroborated impressions that a relatively small proportion of persons entering mental hospitals tend to become chronically disabled and require large quantities of care-giving services. It is concluded that a period of consolidation and replanning is necessary in community psychiatry. It is suggested that early identification of potentially chronic patients, intensive social training, and specialized community living arrangements focused on this group might provide a break-through in rehabilitation of the mentally ill.