Innovations in Helping Chronic Patients: College Students in a Mental Institution

The project paired undergraduate college students with chronic, hospitalized schizophrenic patients at Rochester State Hospital. Students served as group leaders, meeting with eight patients twice weekly for seven and a half months . Rappaport, Chinsky, and Cowen state explicitly that the main difference between their project and other volunteer work was the extent of their evaluation: over one thousand man-hours were spent in subject testing and assessment . This investment in rigorous documentation distinguished the project from typical volunteer efforts and allowed the authors to draw empirically grounded conclusions about what worked, for whom, and why. The project also treated the institution itself as an object of analysis, examining how a custodial state hospital could be mobilized toward active treatment .

The test findings were described by reviewers as 'not surprising': poorly functioning patients improved the most; patients in volunteer-led groups improved slightly more than control groups; most improvement was found in male groups with female volunteer leaders; and there was little carry-over from group sessions to ward life, suggesting future projects should involve ward personnel . On the volunteer side, there was little difference between student volunteers and nonvolunteers; analysis of student personality failed to predict patient improvement . The authors concluded that small patient gains at small institutional cost made volunteer help an important component of treatment programs for chronic patients—a pragmatic conclusion rather than an enthusiastic endorsement.

A central argument of the book, developed in its second chapter, is that the state hospital's social system itself must change for treatment innovations to succeed. Rappaport, Chinsky, and Cowen explicitly analyzed their research project as a tool for system change, arguing that introducing innovations into a custodial institution requires understanding the institution as the target . The reviewer for Social Service Review noted that this chapter 'could benefit anyone desiring to introduce an innovation into a state hospital' . This framing anticipated Rappaport's later insistence that community psychology must attend to settings and systems, not just individuals—that the question of how to change institutions is as important as the question of how to help patients.

Reviews were mixed but generally appreciative of the book's honesty and practical value. Lynn Harold Vogel, writing in Social Service Review, praised the authors for writing 'in a very deliberate and logical manner without losing personality' and called the book 'a pleasure to read,' though he noted its limited findings would restrict its usefulness . Ellen Loeffler's review in Contemporary Psychology was more critical of the book's broad intended audience—researchers, students, professional and nonprofessional caregivers—noting that it 'sometimes wavers between being a human interest story, a how-to book in so many lessons, and an often insurmountable maze of statistics and graphs' . Both reviewers acknowledged the value of Chapter 7, which narrates the project's frustrations, humor, joy, and sorrow in personal terms.

The book is Rappaport's first major publication and shows him working through problems that would define his career. The use of nonprofessional volunteers responds directly to the manpower shortage documented by George Albee in Mental Health Manpower Trends (1959), which demonstrated that professional training could never meet population needs. But Rappaport's distinctive contribution here is the emphasis on institutional and systemic change—a theme that would become central in his 1977 textbook Community Psychology: Values, Research, and Action. The book's concern with the mutual benefits of helping for both patients and volunteers also anticipates his later interest in empowerment and the psychological gains of participation in helping relationships .

The findings were modest and the authors were candid about them: patient gains were small, carry-over to ward life was minimal, and volunteer characteristics did not predict outcomes . The study was conducted at a single state hospital with a specific population of chronic schizophrenic patients and undergraduate volunteers from the University of Rochester, limiting generalizability. Loeffler's review noted that the book's attempt to serve multiple audiences—researchers, students, practitioners—sometimes made it uneven in tone and accessibility . The book is best read as a detailed case study of one attempt at institutional innovation, rich in practical lessons and honest about difficulties, rather than as a definitive demonstration of volunteer effectiveness.