A historical review of the Madison model of community care.

The community-based mental health care programs developed by Stein, Test, and their colleagues in Madison, Wisconsin, have had a profound impact on the delivery of mental health services to the severely mentally ill. The authors trace the development of the model from its late-1960s emphasis on improving Mendota State Hospital and providing intensive post-discharge care through the phases of releasing patients early to the community, preventing hospitalization, providing continuous community care for young schizophrenics, maintaining difficult patients in the community, and organizing a system of care. Throughout its evolution the model has changed significantly in response to changing circumstances, reflecting the assertive adaptability of the approach. Program planners attempting to incorporate elements of the Madison model in their own settings must be aware of current pressures that are likely to force further adaptations.