Public health policy, community services, and outcomes for patients with schizophrenia.

Amidst the specter of managed care, individual mental health services are struggling to redefine their niche, consolidate with partners and provide a realistic continuum of care for persons with serious and persistent mental illness. Because of the chronicity of schizophrenia, its economic and social ramifications, the disparity in health insurance for these patients and limited resources, the development of community services has often proceeded in a fragmentary manner. Several states have well coordinated community programs with integration between private and public services. The Assertive Community Treatment (ACT) model has proved successful, although this is costly to maintain. Services that synergize optimum pharmacologic and psychosocial treatments can achieve favorable patient outcome, as evaluated across clinical, rehabilitative, humanitarian, and public welfare domains.