the installation of community care services in many countries has led to a differentiated set of mental health services and various stepped rehabilitative services which should meet the different degrees and kinds of patients needs in the areas of housing activities and social relationships it is generally agreed that mental health reforms have produced better outcomes in countries where the reduction of inpatient capacities has been compensated by a substantial building up of specialised outpatient and rehabilitative services this holds also true for the united states glied and frank however the reforms have not yet reduced the institutionalisation of people with mental disorders although institutions per se are not ineffective communitybased care has obviously not led to the desired degree of social inclusion independent living or to paid employment