Worlds that fail: A longitudinal study of urban mental patients

This longitudinal study of state mental patients in Chicago investigated patient adjustment to everyday living outside state hospitals. Respondents (N = 313) were interviewed in person at the hospital and at two successive waves in the community, and a wide range of variables was measured. Findings showed that mental patients are overwhelmingly poor, unemployed, and on welfare. A substantial number are homeless, and many resort to criminal behavior as a means of support. The state hospital is often viewed as a place for meals, shelter, and companionship. Only about half of the patients receive help before returning to the hospital, and that help is mostly medication. Those who are younger and have a history of prior institutionalizations are most likely to be readmitted. Patients who refuse to sign into the state hospital are frequently persuaded or coerced to admit themselves “voluntarily” in order to circumvent the complicated involuntary commitment process. It is suggested that mental health care focus on helping patients handle everyday problems in living related to housing, jobs, and interpersonal relationships.