The pattern of social expectations, for a person in long-term institutional care, may have grown to include a forecast of continuing need for inpatient care, a forecast made with infrequent clinical review. A highly organized day and social system are the central features of a program for returning previously desocialized patients from mental hospitals to productive citizenship. A third of a cohort of 66 patients with an average 14 years previous hospitalization had been converted to outside, independent lives at an 18-month follow-up. The patient group selected had an age and physical health status compatible with active employment so that the job-skill aspect of the program would be meaningful. Patients become interested in the nonhospital world as a result of a highly demanding, challenging culture and conventional, nonpatienthood expectations created within the program.