The client group referred to as the long-term mentally ill, the
persistently severely mentally distressed, the chronically psychotic
ill, or people with long-term mental health problems have generally
received a poor deal from the traditional psychiatric services. Help has
largely rested on custodial and medical treatments. The main focus of
rehabilitative ap- proaches has often been dictated by predetermined
expecta- tions which are usually set quite low. The assumption is often
made that people in this client group are 'treatment resistant' and
unlikely to make good use of opportunities to develop personal skills
towards restructuring their lives. Though the emphasis of treatment has
often followed medical approaches, and many non-medical people have
sought to lay blame on the medical model (as characterized by diagnosis
and medical treatments), it would be wrong and greatly over-generalized
to follow this line of criticism entirely. In reality, some
psychiatrists have been the pioneers and advocates of the diversity of
approaches to community support, medical and non-medical. It is they who
have often supported the development of other professionals and
non-professionals and who often lead the pioneering efforts of research
into methods of treatment and support.