The "Halfway house": a transitional facility for the rehabilitation of the mentally ill

There has been a recent and widespread interest in developing new methods of assisting the mental hospital patient in becoming a self-supporting member of society. A new concept, that of "the therapeutic community", has provided insight as to the significance of both physical surroundings and the staff interaction upon the patient's potential for return to the community. Many mental hospital patients become sufficiently free of symptoms to be able to leave hospital, but require further assistance before being able to do so. It is in this context that various kinds of transitional facilities are now being established. The present study examines one such facility, the "halfway house", and attempts by a comparative survey an "operational definition" of its distinguishing features. The several areas requiring descriptive data were assembled in a questionnaire, which was then sent to all centres which could be located from available references on the subject. Responses were received from twelve examples in the United States, to which are added two from British Columbia. A brief reference only is included for "hostels" which are of comparable character in Britain. The introductory chapter reviews the perspective of these institutions. This points up rehabilitation as a process that involves many elements, such as the removal of disabilities incurred as a result of being a mental hospital patient, the necessity of providing for gradual reintegration of the patient into the community, the development of new resources to help accomplish this goal, and the changing attitude developed by service personnel in both the large institution and the transitional facility, so that the patient will be able to receive the encouragement and assistance required. The core material, compiled from the questionnaire, is analyzed under the headings of (a) the new features of this social agency, (b) sponsorship and finance, (c) physical facilities, (d) the nature of staff and facilities, (e) eligibility (Chapter II). Dynamically, the "halfway house" is assessed as a therapeutic community, covering (a) staff functions, (b) the residents' progression, (d) special services, (e) discharge criteria (Chapter III). The conclusions are that the "halfway house" is a new type of social agency that has developed within the last decade. Although it has some similarities with boarding homes, it also retains some of the characteristics of mental hospitals with which it is usually linked. All but one of the examples stress the movement of individuals or clients into the community, and in order to accomplish this, a team of personnel has developed: the houseparent, social worker, and psychiatrist. The makeup of the team is analogous to the mental hospital treatment team of nurse, social worker, psychiatrist. Two elements remain unclear: (a) the policy with regard to eligibility or selection and discharge, and (b) the function of the houseparent. With regard to the former, such matters as high cost of service to the client or policy limiting who is accepted may limit the service. In some cases it is not clear why persons are admitted, except on the basis of unclearly stated need. Some facilities have a clearer view of purpose; i.e., to remove dependency upon the mental hospital or to teach the former patient the social skills required for living in the community. But many houseparents, lacking professional education, are nevertheless responsible for the physical order of the facility and for setting a therapeutic tone. Some suggested areas for further study are better definitions of the hospital disabilities removed by a stay at the agency, and closer examination of how social interaction amongst clients and staff, as well as the use of community resources, brings this about.Arts, Faculty ofSocial Work, School ofGraduat