Are those individuals who were formerly placed on the back wards of the state mental hospital drifting to the back alleys of the community? There is some evidence to suggest that the erosion of the state hospitals system has led communities to develop new methods of excluding their mentally ill. Viewing inclusion and exclusion efforts as a function of social distance, we have reviewed empirical data on the nature of attitudinal response to the mentally ill. Implications of public attitudinal response to this group are considered with respect to providing the necessary incentives for inclusion. Taking California as an example, we also attempt to conceptualize and classify actual community response patterns in the light of what appears to be the development of new formal and informal mechanisms of exclusion.

This research describes the extent of use of antipsychotic drugs in sheltered-care and examines the effect of these drugs by dosage, age group and psychopathology on rehospitalization and social integration. Data were collected from a large sample of former mental patients representative of all non-retarded mentally ill between 18 and 65 living in community-based sheltered-care in California. Findings suggest that antipsychotic drugs, when used with limited medical supervision, have detrimental effects on the social functioning of the least disturbed. While antipsychotics may short circuit the psychotic process and thereby reduce mental hospital readmissions, social programming is necessary to promote better social functioning.