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In this article, the performance of community support programs over three decades is assessed through a review of the professional literature, with emphasis on clinical outcomes, cost-effectiveness, and consumer satisfaction. The author argues that for managed behavioral health organizations to serve disabled customers adequately, community support is required. Ten field-tested reasons to include community support services in every behavioral health plan are presented. The author concludes that social workers are uniquely qualified to adapt proven interventions from model community support programs to the mission of managed behavioral health organizations, with the potential to remedy problems of access, continuity, and accountability in providing treatment for serious and persistent mental illness.

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In a group of depressed manic-depressive patients, urinary adrenalin, noradrenalin, creatinine and volume on admission of the patients to hospital were significantly reduced compared to the values found on their discharge. A small sample of manic-depressed manic patients showed significant elevations in the urinary output of dopamine on both admission and discharge from hospital. A group of schizophrenic patients revealed no over-all difference between the amounts of adrenalin and noradrenalin excreted at the time of their admission to hospital when they were ‘sick’ and the values found when they were discharged as ‘recovered’. The magnitude of excretion of these two amines by this group was at both stages comparable to that of the group of manic-depressive patients on discharge. There was no correlation between catecholamine excretion and clinically rated thought disorder. The more anxious manic patients were and the more bodily symptoms they had, the higher their excretion of noradrenalin. In depressed patients the greater the anxiety and depression, the higher was the excretion of all three catecholamines and the fewer were the bodily symptoms.