Abstract
This manual for practitioners will become a useful book for any mental health worker who is interested in working in the community in an outreach setting. Every page demonstrates the long and valuable experience of the two authors, particularly in the UK setting. For Australian and New Zealand readers the assertive outreach teams as described in this book would most closely resemble the Mobile Support/Treatment Teams. The book is divided into 3 parts, Conceptual Issues, Health and Social Care Practice, and Structural Issues.
Part 1, Conceptual Issues, provides a good historical overview of assertive outreach followed by a discussion of which patients/clients are and are not suitable for assertive outreach. The vexed issue of 24-hour teams versus extended hours teams is explored. The importance of establishing an agreed model for the team is emphasized. This consists of small caseloads, 10 patients (at times up to 15 patients) per full-time key worker (case manager). The team must offer flexible and frequent contact, visiting once or twice a week, and be able to offer a crisis response if this is required. In the Australasian setting the crisis response may be provided by workers either within an integrated outreach team or by a separate crisis response team. Assertive outreach teams are multidisciplinary, consisting of medical, nursing and allied health members. The role of compulsory (involuntary) treatment in the community is described, particularly in the context of the current mental health legislation in the UK, which is expected to change in the near future. Conversely, for mental health workers in an Australasian setting the use of Community Treatment Orders is an established procedure. The chapter on cultural sensitivity is fascinating and shows the enormous development of this approach which has taken place in the UK in recent years and provides useful guidance for outreach services that may wish to follow this path in the future.
Part 2, Health and Social Care Practice, deals with a range of approaches to the delivery of services. The essential topic of medication compliance is well balanced and provides a 3-phase model for compliance therapy, which all workers should find useful. Risk assessment and management is covered with interesting examples of the documentation that is used by the team. There are chapters on all the major diagnostic groups plus a helpful chapter on the broad topic of self-neglect. Substance abuse receives appropriate attention including a guide to motivational interviewing. The need to provide assistance to patients in managing their finances is recognized and is dealt with in the context of the UK legislation. The authors note the importance of employment to patients and applaud the models, which have been established in the USA. My favourite chapter is on psychosocial interventions and work with families. This covers psychoeducation, behavioural family management and cognitive behaviour therapy. There are some tips on different strategies which all outreach workers could consider. The need for workers to receive additional training in some of these skills is noted as well as the substantial benefits that can flow on to both patients and their families. Although first episode psychotic illnesses are mentioned early in the book it is disappointing to note the lack of a specific approach to this critical group of patients.
Part 3 deals with Structural Issues. The roles of the team leader and the consultant psychiatrist are described. There is even a suggested weekly format for meetings such as handovers, community review meetings and business meetings. Issues of accountability and responsibility are covered. Both management supervision and clinical supervision are also explored. There is a chapter dealing with training, which covers both basic competencies and those additional competencies, which professionally trained key workers (case managers) should possess. The chapter on service planning issues is clearly set in the UK context although many of the issues, such as risk assessment and the concept of an integrated model will have relevance for Australasian workers. The final chapter is on research and development and covers the important topics of service evaluation and some of the basic principles of setting up a research project.
In summary, very experienced clinicians have written this manual for clinicians and managers in the workplace. It is comprehensive and practically focused and will especially appeal to those professional staff who are considering taking up a position in a service that offers an assertive outreach programme.