The mental health movement of early release into the community of the chronic schizophrenic has been based on a set of old theoretical assumptions and expectations which, when tested on the community level, failed to meet the desired results. On the contrary, the first visible outcome of deinstitutionalization was the revolving door policy with the patients repeatedly in and out of the hospital, changing their previous status of inpatient to the new one of pseudoam bulatory. Yet, this would not be a serious problem if the life of the patient in the community, in between rehospitalizations, was beneficial to him and to the community. However, the quality of life experienced by the patients in the community appears to be deplorable. Available statistics indicate that over 70% of chronic schizophrenics discharged into the community live a marginal, unproductive, aimless life in dilapidated hotels or private proprietary homes. Certainly, though there are various scattered community programs for the rehabilitation of the schizophrenic, the results are far from encouraging. With these basic facts in mind, we have to ask ourselves: What went wrong with deinstitutionalization? Apparently in the process of hasty deinstitutionaliza tion, too many issues were overlooked by the community mental health planners. The most critical factor neglected by the policy makers was the establishment of more realistic criteria for the patient who can or cannot function in the community.

This handbook features in-depth reviews of disability-adjusted life years (DALYs), quality-adjusted life years (QALYs), quality of life and financial measures for over 120 diseases and conditions. Its editors have organized this critical information for maximum access and ease of use, with abstracts, definitions of key terms, summary points, and dozens of figures and tables that can enhance the text or stand alone.

Brain disordersâ€"neurological, psychiatric, and developmentalâ€"now affect at least 250 million people in the developing world, and this number is expected to rise as life expectancy increases. Yet public and private health systems in developing countries have paid relatively little attention to brain disorders. The negative attitudes, prejudice, and stigma that often surround many of these disorders have contributed to this neglect. Lacking proper diagnosis and treatment, millions of individual lives are lost to disability and death. Such conditions exact both personal and economic costs on families, communities, and nations. The report describes the causes and risk factors associated with brain disorders. It focuses on six representative brain disorders that are prevalent in developing countries: developmental disabilities, epilepsy, schizophrenia, bipolar disorder, depression, and stroke. The report makes detailed recommendations of ways to reduce the toll exacted by these six disorders. In broader strokes, the report also proposes six major strategies toward reducing the overall burden of brain disorders in the developing world.

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

This unique manual presents cognitive-behavioral social skills training (CBSST), a step-by-step, empirically supported intervention that helps clients with schizophrenia achieve recovery goals related to living, learning, working, and socializing. CBSST interweaves three evidence-based practices--cognitive-behavioral therapy, social skills training, and problem-solving training--and can be delivered in individual or group contexts. Highly user friendly, the manual includes provider scripts, teaching tools, and engaging exercises and activities. Reproducible consumer workbooks for each module include skills summaries and worksheets. The large-size format facilitates photocopying; purchasers also get access to a Web page where they can download and print the reproducible materials. Listed in SAMHSA's National Registry of Evidence-Based Programs and Practices