Abstract
Inpatient child psychiatric units have evolved dramatically since their introduction in 1947. This book provides a broad overview of the field as practised in the United Kingdom at present, and the challenges to be overcome in the future.
Containing 34 chapters divided into nine parts, this handbook gives clear information on the key issues that require consideration to enable effective functioning of a child psychiatry inpatient unit and the provision of therapeutic intervention.
The first part of the book addresses the current context of child inpatient services in the UK, historical themes, the challenges of changes in practice and a description of current practice. The treatment process, influences on the decision to refer for admission, some methods of negotiating admission goals and contracts and some ideas regarding treatment and discharge planning constitute the second part.
Part three is titled ‘Therapeutic elements in in-patient treatment’. Chapters dedicated to discussing behavioural and cognitive therapies, psychodynamic psychotherapy, educational management and family therapy have tended to focus on providing a summary of the techniques used rather than the unique aspects of these therapies in the inpatient unit. Unfortunately, there is only one chapter on the ward as a therapeutic agent in its own right and the use of groups, peer relationships and the milieu.
The fourth part, ‘Team organisation and dynamics’, provides an excellent introduction to the person considering the need for management of the multi-disciplinary team, the dynamics of the team, some useful models from management theory and the need for staff supervision and support.
The largest part of the book is ‘Critical areas of management’. The section on ward issues (aggressive behaviour management, child maltreatment in inpatient units and unwanted effects of in-patient treatment) has been thoughtfully written and is the best in this part. The chapters addressing the ‘Management of some specific disorders’ would fit equally well in a general child psychiatry text, with only the chapter on obsessive-compulsive disorder focusing on the unique aspects of this disorder as it relates to inpatient settings.
The lack of research into the efficacy of child psychiatric inpatient units is highlighted by the two chapters dedicated to research, being the shortest in the book.
The section dedicated to management and finance contains chapters on issues that are gaining prominence in our own services; economic evaluation, commissioning and contracting and, perhaps of most interest, the contentious issue of consent.
The book closes with a brief description of two other residential options and conclusions.
Each of the 22 contributors has provided some of their individual experience and philosophy so that no one method of practice is given prominence. A variety of approaches is discussed and it is this characteristic that enables this book to stand apart from many previous works on the topic. A limitation is its focus on the UK.
Although it would seem that the obvious buyers for this book would be members of inpatient services, I believe its most valuable contribution will be to persons working in the area of child and adolescent mental health who have had minimal exposure to inpatient services, by informing them of ways in which inpatient units can help meet the complex needs of their patients.