Chronic Psychiatric Patients in the Day Hospital

MANY perplexing issues are raised when a community mental health service attempts rehabilitation of a chronic patient. The complexity of these problems is compounded in this country, where the orientation and training of mental health professionals is not primarily directed toward the chronically mentally ill.¹

The Challenge of the Chronic Patient.—The patients with whom we are concerned in this paper are those presenting problems of chronic and severe mental illness, chronic poor functioning, chronic regression, and chronic dependency. The rehabilitation of these patients requires a philosophy of treatment that is in many ways alien to the usual thinking of many mental health professionals. We have to recognize that we are dealing with borderline, marginal people, both socially and vocationally, for whom life is a constant struggle. Their tendency is to regress when faced with a stressful situation. They are skilled at evoking