In the mid-1970s, a series of meetings at the National Institute of Mental Health (NIMH) gave birth to the idea of a community support system (CSS), a concept of how services should be provided to help persons with long-term psychiatric disabilities (Turner & TenHoor, 1978). Recognizing that postdeinstitutionalization services were unacceptable, the CSS described the array of services that the mental health system needed for persons with severe psychiatric disabilities (Stroul, 1989). The CSS filled the conceptual vacuum resulting from the aftermath of deinstitutionalization (Test, 1984). The CSS was defined (Turner & Schifren, 1979, p. 2) as “a network of 522 CHANGING TOWARD THE FUTURE caring and responsible people committed to assisting a vulnerable population meet their needs and develop their potentials without being unnecessarily isolated or excluded from the community.” The CSS concept identifies the essential components needed by a community to provide adequate services and support to persons who are psychiatrically disabled.
The essential components of a CSS have been demonstrated and evaluated since its inception. Test (1984) concluded from her review that programs providing more CSS functions seem to be more effective (with fewer rehospitalizations and improved social adjustment in some cases) than programs that provide fewer CSS functions. More recently, Anthony and Blanch (1989) reviewed data relevant to CSS and concluded that research in the 1980s documented the need for the array of services and supports originally posited by the CSS concept.
It appears that the need for the component services of CSS has a base in empiricism as well as in logic. Most comprehensive mental health system initiatives in the 1980s can be traced to the CSS conceptualization (National Institute of Mental Health, 1987).
Based on the CSS framework, the Center for Psychiatric Rehabilitation has refined and defined the services fundamental to meeting the wants and needs of persons with long-term mental illness. Table 1 presents these essential client services.
