Outreach in Community Mental Health Care

The last 50 years has witnessed a radical change in the care of the severely mentally ill as asylums have closed and care has moved to the community. Two developments have marked this transition. The first is the development of multidisciplinary community mental health teams (CMHTs). The second is an increasing reliance on outreach to engage and support the most seriously ill patients. This book is a guide for those, whatever their professional background, who work in CMHTs. It focuses on the practicalities of the job—what they all need to know, whether coming to it from social work, nursing, or psychology. It is based on our decade of working together in an assertive outreach team and our backgrounds in nursing and psychiatry in a range of CMHTs.The book is in three parts. The first addresses the underlying principles of the practice and its variations. It explores the themes that are common to all outreach work and the specific thinking and practice characterizing different teams and settings. The second section addresses the range of problems faced by the outreach worker. These include the challenges presented by different diagnoses, plus those of hostility, homelessness, suicidality, and the omnipresent complications of drug and alcohol abuse. Psychosocial interventions aimed to promote employment and social stability are outlined with clinical examples. The third section explores the structural issues of managing the team, providing effective supervision, and conducting research. We draw on relevant research when appropriate, but the style of the book is practical, based primarily on accumulated experience.