recidivism, patient Downloaded from by guest on 23 November 2021 VOL. 12, NO. 4, 1988 553 self-esteem, and patient instrumental and role performance. Remediation of Handicap. In addition to clinical rehabilitation interventions of skill and support development, psychiatrically disabled persons can be helped to overcome their handicaps through societal rehabilitation interventions (Anthony 1972). Societal rehabilitation is designed to change the system in which psychiatrically disabled persons must function. Unlike clinical rehabilitation, its focus is neither on the skills of specific psychiatrically disabled individuals nor on their unique environments. Rather, the focus is on system changes that can help many psychiatrically disabled persons overcome their handicaps. Examples of this type of system intervention are the Targeted Job Tax Credit legislation, changes in the length of the trial work period in the Social Security Disability program, and the development of a European-type quota system for the employment of disabled workers. The importance of these system-type interventions cannot be overemphasized. Obstacles in overcoming a handicap may be more a function of a nonaccommodating and discriminating social and economic system than of the person's impairment and disability. Community support programs are another example of a system-wide response to the problems of persons who are severely psychiatrically disabled (Turner and TenHoor 1978). Clinical and societal rehabilitation interventions are not mutually exclusive. As a matter of fact, the 1973 amendments to the Vocational Rehabilitation Act recognize the value of societal rehabilitation efforts. The amendments established the principle of affirmative action by contractors who do business with the Federal Government and also attempted to establish the Government as a model employer with respect to architectural access (Stubbins 1982). Integrating Rehabilitation Strategies In view of the pervasive impairments, disabilities, and handicaps of most persons with chronic mental disorders, a combined approach to psychiatric rehabilitation, employing skills training and environmental modification strategies, is most often required. As the following case vignette illustrates, the rehabilitation practitioner or team needs to integrate skills training, social support, and governmental incentives and regulations to bring about an optimal outcome. A 30-year-old male with a 15-year history of being in and out of private and State psychiatric hospitals decided he would like to get a job in the community after being in a psychosocial work adjustment program for 1 year. He did not have a good work history; for example, 6 months was the longest he had ever been able to hold a job. Using the targeted job tax credit legislation as an incentive to the employer, the psychiatric rehabilitation team was able to find the disabled person a job working in a video repair shop, a job consistent witn the client's interests and talents. To keep his job at the repair shop, the patient needed to learn the skills of taking orders from authority -s (showing understanding of wnat others say and expressing his own thoughts and feelings to others). The team also made the environment more supportive to the patient by educating the employer to the patient's needs, and obtained employer agreement on reducing the initial work load/time until the disabled person became comfortable with the new environment. In general, all available interventions are used in combination—psychotropic medication; partial and full hospitalization; case management; skills training; social self-help clubs; and environmental support initiatives—to achieve the maximum degree of adaptation that is feasible. The emphasis on each of the types of intervention varies with the nature of the disorder, the premorbid level of competence of the patient, and the phase of illness. Historically, mental health treatment has tried to develop interventions aimed at the patient's impairments. Somatic and psychological treatment efforts have attempted to alleviate the signs and symptoms of psychopathology. Leitner and Drasgow (1972), in analyzing the