Outcomes of patients with schizophrenia in a family-style, residential, community-based program in Italy

Environments for the care, treatment, and rehabilitation of persons with mental disorders have taken many forms, ranging from sheltered and isolated asylums to mainstream community-based programs with specialized supports. Since the 1960s, and concurrent with the civil lights movement for mental patients, providing treatment outside of mental institutions in the least restrictive setting has been emphasized by mental health advocates and supported by several legal decisions in the United States (1). However, one challenge that has arisen is the need to balance the requirement of delivering treatment in the least restrictive setting with the benefit of providing comprehensive psychiatric rehabilitation services that are well coordinated and continuously available. One solution to this dilemma has been to embed psychiatric rehabilitation techniques within a residential program, such as was done with good outcomes at Soteria House (2) and in social learning programs in the 1970s (3). However, despite these and several other successful efforts to provide residential alternatives to long-term hospitalization (4), in most parts of the United States the provision of psychiatric rehabilitation services is not linked to housing. In this column, Dr. Guazzelli and his colleagues from the University of Pisa describe a program that combines the basic philosophy of providing a long-term, community-based residential alternative to hospitalization with a commitment to the use of evidence-based psychiatric rehabilitation techniques. They also report the results of an evaluation of two-year outcomes for program residents with schizophrenia.