Essential Principles in the Delivery of Adequate Clinical Care to the Chronic Psychiatric Patient in the Community

Abstract

Effective management of the chronic psychiatric patient in the community requires recognition of its complexity in a variety of ways. First, when one attempts to define the chronic patient, it is immediately apparent that a broad group of psychiatric patients could be so labelled. In particular, schizophrenic and paranoid disorders, the affective disorders and the personality disorders can all persist for years or typically run a course of remissions and exacerbations throughout a person’s lifetime. Further, the degree of disorder, irrespective of diagnosis, can be extremely variable. Some patients are easily managed by a single clinician who is able to achieve a working alliance with the patient who is insightful and cooperative. Others are extremely vulnerable to totally disabling aberrations of thought and behavior, have no insight, and have little motivation to work with an entire team of rehabilitative mental health professionals, who find themselves exhausted at the effort.