title: Chronic mental illness and community treatment resistance.
abstract: OBJECTIVE
  The movement from institutional to community care has been a key component of national mental health reform in Australia. In Victoria, where a model of community care has been fully implemented, a specialized forensic hospital is the sole remaining stand-alone psychiatric inpatient facility and access to long-term inpatient beds is severely limited. Clinical experience suggests that some high-needs patients are not well serviced by this structure. These patients are placing an increasing burden on a wide range of community services outside mental health. This paper aims to define more clearly this patient group, explore the limitations of their management and outline potential pathways for service development.
  
  
  CONCLUSIONS
  A population of complex patients with chronic mental illness are not effectively contained within a 'good enough' community-based mental health system. Active debate is required regarding the community's willingness to tolerate the risks and challenges that arise from the current approach. A collaborative care model involving case-based and incentive funding in combination with community-integrated complex care units may improve the care of these patients.
authors.affiliation: University of Melbourne and Inner West Area Mental Health Service, Melbourne, Vic., Australia. acnh@unimelb.edu.au
authors.forename: Alex
authors.initials: A
authors.lastname: Holmes
authors.forename: Mark
authors.initials: M
authors.lastname: Hodge
authors.forename: Simon
authors.initials: S
authors.lastname: Lenten
authors.forename: John
authors.initials: J
authors.lastname: Fielding
authors.forename: David
authors.initials: D
authors.lastname: Castle
authors.forename: Dennis
authors.initials: D
authors.lastname: Velakoulis
authors.forename: Gail
authors.initials: G
authors.lastname: Bradley
mesh_terms: D000328:Adult; D000987:Antisocial Personality Disorder / Q000150:complications / Q000628:therapy*; D002908:Chronic Disease; D003156:Community Mental Health Services; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012563:Schizophrenia, Paranoid / Q000150:complications / Q000628:therapy*; D012944:Social Support