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Despite more than 30 years of deinstitutionalization, a significant number of individuals continue to experience prolonged stays in state psychiatric hospitals. Many of these individuals appear to develop an ambivalence or resistance to discharge. This can itself contribute to further delay in discharge planning and implementation. We will describe a group intervention for persons with long stays labeled as "resistant." This effort was guided by the premise that each individual could benefit from personally exploring those aspects of his or her experience that may be contributing to continued hospitalization. The group utilized standard methods of rehabilitation and training with strong emphasis on validating individual needs and feelings, peer support and practical results. After 1 1/2 years of group intervention, 5 of the 7 group members had achieved discharge and initial community success.

A longitudinal study of psychological disturbance in the affected population in Sri Lanka after the cyclone disaster of 1978 was carried out. The post-cyclonic stress identified among the rural communities after their return to the same destroyed environment was studied. Symptoms tended to be early or delayed in appearance. The degree of unpreparedness is postulated as the causes of the former. Group cohesiveness and feelings of community tended to delay the manifestation of symptoms. Realization of losses, family needs, and continued habitation in damaged homes acted as reminders and reinforcers. Morbidity continued to affect over half the population one year later. Early intervention within community settings after such disasters is recommended.