648 Social Learning for Chronic Mental Inpatients by Shirley Glynn and Kim T. Mueser Abstract With chronic institutionalized psychi- atric patients, an intensive social learning program resulted in greater increases in adaptive functioning, reductions in bizarre behavior, less prescribed medication, and over 98 percent of patients being successfully discharged into the community. The social-learning program was more cost-effective than custodial hospital care, and nonprofessional staff were able to apply the treatment with a high degree of competence. Especially effective elements of the social- learning program included (1) integrated procedures emphasizing the acquisition of patient skills and the reduction of bizarre, inappro- priate behavior; (2) a token economy structure; and (3) consistent pacing and generalization training. More recent research in the area has sought to identify the remediative aspects of social-learning programs, to specify patient variables that are related to improvement in a token economy, and to offer patients more specialized interventions (e.g., social skills training) in conjunction with a standard token economy. With the demonstrated and operationalized efficacy of social-learning procedures, the rehabilitation of chronic psychi- atric patients has become more feasible. The rehabilitation of long-term insti- tutionalized psychiatric patients poses an ongoing challenge to mental health practitioners. Almost 10 years after its publication, the comparative study of a social-learning program for chronic psychiatric patients reported by Paul and Lentz (1977) remains unmatched in both its comprehensiveness and method- ological rigor (see Rhoades 1981). Social-learning procedures appear to be the most cost-effective approach to meeting the treatment needs of low-functioning, institutionalized psychiatric patients. The inadequacy of existing services for the chron- ically mentally ill is reflected in at least three disturbing facts: (1) many psychiatric patients are unable to maintain community tenure; (2) even "rehabilitated" chronic patients often have severe deficits in self-care and social skills; and (3) patients in tradi- tional institutional settings are under- stimulated and frequently lead barren lives. Rehospitalization rates for psychi- atric patients range from 35 to 50 percent within the first year postdischarge (e.g., Friedman, Von Mering, and Hinko 1966; Wolkon, Karman, and Tanaka 1968). About 60 percent of public psychiatric beds are occupied by patients who have been continuously hospitalized for more than 1 year, and as many as 90 percent of these patients are unresponsive to pharmacological treatment (Paul 1984). However, even the ability to live in the community is not a guarantee of satisfactory social functioning. Psychiatric patients frequently reside in dismal social conditions in the community (Kirk and Therrien 1975), and the functioning of many chronic patients living in community residential settings actually declines over time (Kohen and Paul 1976; Dickey et al. 1981; Spivack et al. 1982). The inadequacy of chronic patients' social skills may limit their ability to cope with and blunt the noxious effects of stressors, making them more vulnerable to symptom exacerbations (Liberman 1982). While social deficits of patients in the community lead to social rejection Reprint requests should be sent to Dr S Glynn, Camanllo'UCLA Research Center. Box A. Camanllo, CA 93011 by guest on February 25, 2016 http://schizophreniabulletin.oxfordjournals.org/ Downloaded from