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 me ntal disorders have taken many forms, ranging from sheltered and isolated a sylums to mainstream community-based programs with specialized supports. Si nce the 1960s, and concurrent with the civil lights movement for mental pat ients, providing treatment outside of mental institutions in the least rest rictive setting has been emphasized by mental health advocates and supporte d by several legal decisions in the United States (1). However, one challen ge that has arisen is the need to balance the requirement of delivering tre atment in the least restrictive setting with the benefit of providing compr ehensive psychiatric rehabilitation services that are well coordinated and continuously available. One solution to this dilemma has been to embed psychiatric rehabilitation t echniques within a residential program, such as was done with good outcomes at Soteria House (2) and in social learning programs in the 1970s (3). How ever, despite these and several other successful efforts to provide residen tial alternatives to long-term hospitalization (4), in most parts of the Un ited States the provision of psychiatric rehabilitation services is not lin ked to housing. In this column, Dr. Guazzelli and his colleagues from the University of Pis a describe a program that combines the basic philosophy of providing a long -term, community-based residential alternative to hospitalization with a co mmitment to the use of evidence-based psychiatric rehabilitation techniques . They also report the results of an evaluation of two-year outcomes for pr ogram residents with schizophrenia.