The Thresholds parents group gives the parents of clients an opportunity that has rarely been presented to them. They are able to discuss openly, with their peers, many issues that have not been expressed previously except in the greatest privacy. Often their children's mental illness has been a well-kept secret or has been handled in a guilty and shamefaced way. They do not find it easy, as a rule, to discuss mental illness in the same way they might discuss diabetes or congenital heart disease. It is an enormous relief to be open about their problems with others who are in similar circumstances. The main issues addressed in the group are a redefinition of good parenting to include mutual disengagement, emancipation, and separation; reduction of parental guilt, with its consequent implications of parents getting more out of their own lives, and a reduction of manipulation; and the handling of management issues such as money, medication, visiting, parental expectations, holidays, siblings, and parents' united front. Parents of the emotionally ill are a much maligned group. Too often they are regarded by the mental health community as enemies and not allies. Too often the suffering that they have endured is ignored. Too often parents' strengths are overlooked by mental health professionals treating their offspring. And, finally, too often basic change in the parents is demanded as a prerequisite for meaningful change in the member.

Abstract[Excerpt] This article describes some of the lessons learned in the implementation of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) as it relates to people with psychiatric disabilities. It attempts to articulate some of the inherent difficulties faced in serving these individuals within the welfare system as well as how the established strengths of each system can inform the other's efforts. The philosophy concerning work for clients of the welfare and mental health systems differ. Each system has developed separately, and they do not easily integrate their differing philosophies and goals. At the client level, this lack of consistency presents obvious coordination barriers. At the system level, examination of practice and the underlying philosophy of each provides incentives for cross-training and policy changes. Two case studies describe the identification of issues, opportunities, and challenges to providing Temporary Assistance for Needy Families (TANF) services to individuals with mental illness. These lessons can provide guidance to mental health systems as they strive to implement evidence-based employment practices and provide welfare entities with policy direction as a result of a widening knowledge base. Specific policy and program innovations in a county and in a state are highlighted to demonstrate these issues. Finally, the authors raise areas for further inquiry and reflection. This article describes some of the lessons learned in the implementation of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) as it relates to people with psychiatric disabilities. It attempts to articulate some of the inherent difficulties faced in serving these individuals within the welfare system as well as how the established strengths of each system can inform the other's efforts. The philosophy concerning work for clients of the welfare and mental health systems differ. Each system has developed separately, and they do not easily integrate their differing philosophies and goals. At the client level, this lack of consistency presents obvious coordination barriers. At the system level, examination of practice and the underlying philosophy of each provides incentives for cross-training and policy changes. Two case studies describe the identification of issues, opportunities, and challenges to providing Temporary Assistance for Needy Families (TANF) services to individuals with mental illness. These lessons can provide guidance to mental health systems as they strive to implement evidence-based employment practices and provide welfare entities with policy direction as a result of a widening knowledge base. Specific policy and program innovations in a county and in a state are highlighted to demonstrate these issues. Finally, the authors raise areas for further inquiry and reflection.

I would like to respond to the letter by Chamberlin and Zinman that appeared in your last issue. I am disturbed by both the content and the tone of that letter. This Journal is broadly based and provides a forum for the entire field. It shouldn't be construed as the agent of Chamberlin and Zinman, although it should provide an opportunity for their opinions, as it does. (That is why they are on the Editorial Board.)Frankly, their arguments by themselves sound increasingly oldfashioned, and it is clear that they are out of touch with the recent developments in the illness they purport to represent. Thomas Szasz' "myth of mental illness" is a dead idea. Mental illness is just that -an illness, not a myth or a plot by professionals. The history of the illness dates back thousands of years, the AMA did not invent it.Medication accounts for the most profound revolution in the history of mankind's treatment of the mentally ill. Psychotropic medication is efficacious, and there are enough reliable and accurate scientific studies to satisfy virtually everyone that this medication, appropriately administered, reduces symptoms for most people. There is also plenty of satisfactory evidence, both scientific and observational, that a primary antecendent to rehospitalization is medication non-compliance. I believe that the most progressive thing Chamberlin and Zinman could do would be to use their energies crusading with NAMI and others for more medical research and more dollars for effective programs in the community.

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