The development of psychiatry is at present stormy with discussions dividing, polarising and partly paralysing. Current experience shows that psychotherapeutic approaches are not alternatives to psychopharmacological ones but necessary complements. An integrated therapy which treats the patient as a social, psychological and organic entity has not yet been spread to the poorly-equipped psychiatric periphery but is mainly restricted to the modern richly-endowed psychiatric centers. Modern psychiatric rehabilitation principles according to this integrated synoptic view seem however to be applicable even to custodial-treated patients at peripheral psychiatric institutions. In this article we present the special psycho-social, epidemiological, administrative and economical structure of the island of Gotland due to its geographical isolation. We describe the construction and forming of a rehabilitation program under greatly limited economical conditions. The program combines communication-oriented group therapy with consequent pharmacotherapy and a structured ergotherapeutic and ADL-therapeutic program and is applied to a primarily unselected sample of patients. We also describe the education and supervision of the staff as well as the components of our program. Positive results in spite of limited resources have been achieved. Problems are discussed.