The 'ward-in-a-house': residential care for the severely disabled.

This paper is concerned with the care of the most difficult and severely disabled new patients presenting to mental health services in the U.K. Questions of definition will be examined and the clinical and social characteristics of the population discussed. Since the defining characteristics (and prevalence) of this group are strongly affected by the overall service context, the range of community provisions within one health district (Cambridge) will be described. Examples of a new kind of institutional solution-the 'ward-in-a-house'-will then be presented, together with the underlying principles of management and care. The benefits and limitations of the model will be discussed.