rehabilitation as a societal responsibility. The 1943 amendments to the United States Vocational Rehabilitation Act extended financial support and vocational rehabilitation services to the psychiatrically disabled, with similar legislation appearing at the same time in England. These governmental actions provided legitimacy to the idea of training and rehabilitating people with psychiatric disabilities and grounded the practice of psychiatric rehabilitation in the vocational arena. The discovery of the capacity of the mentally retarded for gainful employment (O'Connor and Tizard 1956) led to studies on the effects of psychiatric disability on work and to the introduction of paid industrial subcontract work into large mental hospitals (Carstairs, O'Connor, and Rawnsley 1956). The last three decades have seen the scope of rehabilitation move beyond a singular concern with vocational functioning to additional arenas of social and community functioning, but vocational activity has remained a preeminent ingredient in current rehabilitation practices (Beard, Propst, and Malamud 1982; Grob 1983). For example, Lamb (1982) has written that "work therapy geared to the capability of the individual patient should be a cornerstone of community treatment of the long-term patient" (p. 176). Community Mental Health. The legislation that established community-based treatment for the mentally ill and retarded in the late 1950s and early 1960s endorsed the parity between physical and psychiatric disorders and their treatment. Mental illness and retardation no longer merited removal from society to large institutions; thus, the British Mental Health Act of 1959 supported "forms of training and social services which can be given without bringing patients into hospital as inpatients, or which make it possible to discharge them from hospital sooner" (Royal Commission 1957, p. 76). A new basic assumption prevailed— namely, people with major mental illness should be helped to maintain themselves in the community in as normal a manner as possible. Unfortunately, community mental health centers (CMHCs) failed to provide the comprehensive services needed by the severely psychiatrically disabled (Braun et al. 1981), who were not a high priority population for the CMHCs, perhaps because their interdisciplinary staff members were illequipped with techniques for effective work with chronic psychotics (Liberman, King, and DeRisil976). The deinstitutionalization movement, which accompanied the opening of the CMHCs, fostered an appreciation of the value of work training in the preparation of patients for resettlement in the community. Psychiatrists were forced to match their view of the patient's abilities and disabilities against the realities of adaptation in the "real world." Studies were carried out in industrial therapy programs that showed the benefits and hazards of work for the mentally ill, changed the attitudes of citizens and professionals about the employability of mentally ill persons, and led to job placement programs (Bennett 1983). Consistent with modern concepts of rehabilitation are those additional elements of community mental health ideology—accessibility to and comprehensiveness of services, and continuity of care. The emphasis on treating patients in proximity to their natural families and work settings has now been extended by the initiative of the National Institute of Mental Health for community support programs, which has encouraged State and local investments in a spectrum of services for the chronically mentally ill. In turn, this has meant an infusion of key Downloaded from https://academic.oup.com/schizophreniabulletin/article/12/4/542/1874999 by guest on 23 November 2021 544 SCHIZOPHRENIA BULLETIN operating principles for psychiatric rehabilitation, including case management, coordination, and advocacy with a variety of agencies capable of meeting the full range of needs of persons with severe psychiatric disabilities; involvement of patients and relatives in self-help; and assertive outreach. Instead of expending great effort on reversing the disabling effects of the social breakdown syndrome from institutionalism, community-based rehabilitation has focused on the