This document presents a review of the history of the implementation of de-institutionalization in Queens County, a borough of New York City. A number of issues confronting the mental health profession, the community, the patients, and their families are discussed. It notes that Creedmoor Psychiatric Center, the major provider of services for the severely mentally ill in the Queens County area, now has the largest concentration of former mental patients living in community residences in the state. Events are described beginning in 1970 when the director of Creedmoor matched the needs of the dischargeable patients to the needs of the Rockaway community, a failing beach resort, and, using the talents of the rehabilitation, social work, and nursing staff, created what became the prototype for many of the state's after-care programs. The history of this change is examined against the current needs of the new mentally ill homeless, changing demographics, and political and economic issues. Strategies for intervention, such as the rediscovery of the asylum as a safe harbor for the severely mentally impaired and the use of the "revolving door" or rehospitalization for patients experiencing temporary stress, are discussed. New models of caregiving are proposed, including hybrid services for the dischargeable, but non-placeable patients. (Author/NB)