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al. 1982). There are many patients who for the foreseeable future will remain relatively refractory to skills training and environmental support programs aimed at independent living and full employment. Such individuals can still benefit, however, from rehabilitation. It is possible to improve social adjustment, role performance, and autonomy and quality of life even within the limited opportunities provided by a mental hospital or residential care facility in the community. Research conducted by a large number of investigators in the United States and Europe supports the following conclusions: • Severely psychiatrically disabled persons can learn skills. • The psychiatrically disabled person's skills are positively related to measures of rehabilitation outcome. • Skill development interventions improve the psychiatrically disabled person's rehabilitation outcome. • Environmental resource development improves the psychiatrically disabled person's rehabilitation outcome. In our attempts to conceptualize psychiatric rehabilitation, the "key and lock" analogy might be apt. While it is desirable to maximize an individual's social and instrumental role functioning through training and reeducative procedures, persistent deficits are likely to plague the patient, the family, and the rehabilitation team. Endeavors to upgrade the patient's repertoire of skills hone the "key," but it is often necessary to modify the "lock"—the patient's environment. Recent interventions aimed at modification of the family environment have led to dramatic reductions in relapse, exacerbation, and rehospitalization of patients with schizophrenia (Strachan, this issue). Other examples of environmental prostheses are sheltered workshops, transitional employment, halfway houses, and psychosocial clubs. Guiding the rehabilitation professional is: • Optimism that desirable change is possible if principles of human learning can be harnessed to the needs of the patient. • Belief that motivation for change can come from special arrangements of the patient's rehabilitation and natural environments, as well as from within the patient. • Confidence that by building upon the patient's assets and interests, including supportive treatment and family environments, even small improvements can lead to significant functional changes and uplift the patient's quality of life.