The purpose of this study was to evaluate the effects of vocational services provided to mentally disabled clients of the Fresno County Department of Health by the California State Department of Vocational Rehabilitation located in Fresno, California. The findings were (a) 46% were discharged as employed; (b) cost per client was $1,590: (c) cost per success was $3,448; (d) the employed persons entered a variety of competitive jobs; (e) average annual income for persons employed at discharge was $5,539; (f) persons who were employed were less psychiatrically disabled and had a better work history; (g) only 26% of the severely disabled were employed, compared to 50% of the persons who were mildly or moderately disabled; (h) the main benefit of the program appeared to be that of returning less disabled clients with better work histories to work at normative levels shown prior to vocational services; and (i) cost-benefit analysis showed that annual earned income exceeded program cost.

Clients ready for discharge from the Fresno County Department of Health Acute Psychiatric Unit were randomly assigned to an experimental group (n = 71) or a control group (n = 72). The individuals in the experimental group received community follow-up services from one of four psychiatric social workers for a period of 30 days after their discharge from the acute psychiatric unit. The control group received no follow-up ser vices from the project staff. The evaluation of the project was based on a period of 60 days following each client's discharge from the hospital. The results showed that posthospital community follow-up, as provided in this demonstration project, is effective in preventing or at least delaving rehospitalization, without increasing the cost of mental health care.