CHRONIC MENTALLY ILL TREATMENT REFUSERS: AN EPIDEMIOLOGICAL STUDY AND DESCRIPTION OF A SERVICE DELIVERY PROGRAM (SCHIZOPHRENIA).

Abstract

Professional literature in the past five years regarding the care and treatment of deinstitutionalized chronic mentally ill (CMI) persons has presented growing concerns that services for some CMI persons are inadequate or nonexistent. A number of previous authors have suggested that there may be a consistent, as opposed to a random, bias in the traditional mental health service delivery system whose services are contingent upon client characteristics that, in the very least, assume foresight, independence, initiative, and consistency. Lacking these qualities, clients may not seek services to which they are entitled or they may be frustrated in maintaining those services. This study provides a description of a CMI population (n = 142) that received outreach services from a small county psychiatric hospital. These clients were selected because they were evaluated as severely disturbed, potentially impulsive, and had a history of not following through with traditional mental health services, i.e., they did not make or keep prescribed appointments for therapy or education. This group served as a model against which to compare characteristics of the traditionally engaged clients. Previous authors as well as this study found that the dropout populations were younger, less compliant with prescribed anti-psychotic medication, engaged in more alcohol and drug use, were more likely to live independently and to be rehospitalized with greater frequency. Increased hospitalization also correlated with less functional independent living skills. In other reported research several variables were found to discriminate the younger CMI. This study could only confirm an increase in substance abuse although several confounding factors are discussed. Finally, the outreach program itself was examined, some services were quantified, and some were related to specific client characteristics. For instance, 40 percent of this CMI population was primarily reliant on their outreach worker for all transportation beyond walkable distances; and those clients receiving the most number of outpatient visits were those rated most rejecting of services and those with the poorest independent living skills. The treatment population was found to have reduced their total number of admissions and days hospitalized during the two-year period of investigation.