Finding alternatives to hospitalization for treatment of the mentally ill involves navigating through a confusing maze of options. Among them:
* Weekly sessions with a mental-health professional.
* Day visits at a psycho-social rehabilitation center.
* Round-the-clock placement in a residential facility.
* Out-patient programs at a psychiatric hospital or mental-health center.
In selecting after-care, families not only need to consider practical questions of appropriateness and cost, but they also need to weigh how much caretaking responsibility they are willing to shoulder. Ultimately, the mentally ill and their families may discover that their options are limited.
"Many treatment programs have waiting lists, or if there is an opening, the program may be inappropriate or the prospective client may not meet eligibility requirements," says Bernard Smith, executive director of the National Alliance for the Mentally Ill.
In defense, mental-health professionals say they are trying to provide adequate services, but don't have the funds to fill the demand. The Social Center in Fairfax, for example, has a day program of vocational and social training and also a three-month waiting list. After-care workers complain that during the interim, a mentally ill person may become withdrawn and sick enough to require rehospitalization.
"We would like to expand our program so we could take in more clients and have more flexible hours," says Vera Mellon, executive director of the center. "But given the economic climate, we are looking at cutbacks, not expansion."
Provision of after-care services is complicated further by "fragmentation of responsibility," says Judy Turner, chief of the community support and rehabilitation branch of the National Institute of Mental Health.
"In the hospital it is clear who has responsibility to care for a patient. But as soon as that person leaves the hospital, it is ambiguous because so many county, state and private agencies have responsibility.
"So, the question is who is going to create the residential, vocational and social programs that don't exist, and where is the money coming from?"
"The bottom line is that we need mental-health programs to equal the need that would otherwise be filled by state institutions," says family handbook author Phyllis Vine. "We can't just abandon the mentally ill by refusing treatment inside mental hospitals and then denying them adequate programs for treatment outside.
"So long as after-care programs are not adequate, thousands of the mentally ill will slip through the system."