Work outcomes in family-aided assertive community treatment: vocational rehabilitation for persons with psychotic disorders.

Although there is still controversy about the ultimate wisdom of deinstitutionalization, states generally are continuing to implement this policy (Gralnick, 1985; Okin, 1985; Minkoff, 1987; Lamb, 1991). Hospital census continues to decline and the present mental health agency administrations of most states and countries have embarked on major initiatives to develop treatment and rehabilitation capacity in the local community for the severely mentally ill (SMI) (Bachrach, 1991). Central among these is an emphasis on psychiatric rehabilitation as a core element in the treatment philosophy and in the everyday practice of all clinicians who deal with the SMI population. During the recent era of deinstitutionalization, as community support programs have become increasingly effective in preventing rehospitalization, interest in rehabilitation of the stable, but poorly functioning, mentally ill patient has increased. One perspective on rehabilitation is to divide existing approaches into two categories. In the first, the conventional vocational rehabilitation)) (CVR) model, patients are referred to relatively large, specialized sheltered workshops and vocational training programs, reflecting rehabilitation methods used in state hospitals before deinstitutionalization or approaches adapted from rehabilitation of the physically disabled. These have generally been discrete facilities, in which psychiatric treatment and case management are provided by another, separate mental health clinic. These services have tended to assume that many mentally ill persons will be unable to participate in competitive jobs. One