The deserving and the undeserving: Selectivity and progress in a community care service

Abstract

Despite increasing evidence of the potential efficacy of community services for people with serious and ongoing mental illness, the popular media and professional literature reflect mounting concern regarding those people who do not receive the care they need. For community care services to become more accessible, acceptable and appropriate to the needs of all those people who are disabled by serious mental illness, more information is needed about the people they currently fail to serve. This study addresses this issue by examining the progress, characteristics and views of one hundred consecutive referrals to an exemplary community care service. In particular, those who were accepted for care (60%) are compared with those who themselves refused care (27%), and those who were rejected by the service (9%). The results replicate those of other studies of community care: people accepted for care showed greater improvement in many areas than those who did not get into the service. However, those people rejected by the service differed markedly from those who themselves rejected the service and represented a severely disabled and disturbed group who posed a considerable challenge to services. The personal views, psychiatric and functional characteristics of the people who did not receive specialist care allow recommendations to be made for the development and focus of community services in the future.