| Summary: | The chronically mentally disabled need to be defined as a special needs group in order to receive the social and health services they require for community survival. Their needs can be identified by reviewing the relationships
between chronic mental disability and schizophrenia, poor social margin, long term use of treatment facilities, and poor social and vocational functioning.
Before the 1950's, services to the chronic patient were provided mainly within the asylum system. Although some innovations in psychiatric services were developed earlier, these were directed to patient groups other than the chronically mentally disabled. This tradition of attention to other patient groups has influenced the community
mental health movement of the last 25 years. This movement was expected to provide for the needs of the chronically
disabled in the community as the mental hospitals were reduced in population.
Recognizing that community centered care of the former asylum populations is a technically feasible goal, the National Institute of Mental Health (N.I.M.H.) has proposed a model community system of services for this patient group. This model addresses their special needs, but its application
requires a concerted and coordinated effort by several separate agencies. Recent changes in Canadian health care financing allows a realistic look at the American model.
This paper uses Vancouver Island, British Columbia, as a planning area for services to the chronically mentally
disabled. The population of the area is 441,000. The mental health services available to these patients are reviewed in order to determine the extent of this availability. Criticisms of community services in other jurisdictions were found to be relevant in the planning region. Recommendations are made based on the model service
system developed by N.I.M.H. A comparison of the costs of the existing services to chronic patients and the ideal system shows that the required improvements could be made with little extra cost. === Medicine, Faculty of === Population and Public Health (SPPH), School of === Graduate
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