OBJECTIVE: This paper provides a comprehensive review of research
predicting receipt of aftercare and recidivism (rehospitalization) among
individuals with severe and persistent mental illness. METHODS:
English-language studies were identified by searching PsycLIT from January
1974, the year of a previous comprehensive review of the literature on
recidivism, to March 1994. A heuristic model was used to classify predictor
variables into three categories: client vulnerability, community support,
and system responsiveness. RESULTS: In general, variables related to system
responsiveness were more consistent predictors of receipt of aftercare than
variables related to either client vulnerability or community support.
Community support variables were more consistent predictors of recidivism
than variables in any of the other categories. Assertive community
treatment and receipt of aftercare-both system responsiveness
variables-were also associated with lower rates of rehospitalization.
CONCLUSIONS: Conclusions based on past research should be regarded as
tentative, because of several methodological and theoretical weaknesses.
Multivariate statistics have rarely been used, many of the studies are
based on nonrepresentative samples, and interactions between client- level
variables and system responsiveness variables have rarely been studied.
Much of the research has relied on archival data, and choice of variables
has thus often been guided more by the data available than by theory.