Managing Mental Health in the Community is a guide to best practice in the management of community care for people with mental health problems. A major theme is how to balance the 'triangle of care' that represents the needs and concerns of the user, carer (professional or family) and community. Rather than focusing on the mechanics of the task, this book aims to encourage reflective practice amongst staff, managers and policy-makers. The experienced practitioners who contribute not only challenge some of the assumptions prevalent in the field, but also present some tried and tested interventions used to enable users, staff and managers to function more effectively in community settings. They consider: * how community care has developed * the fundamental concepts of community care * how management is affected by practice * how care systems are designed. Managing Mental Health in the Community should be essential reading for Mental Health Practitioners, Managers, Social Workers, Policy-Makers, Organizational Consultants and all those professionals who are committed to improving the quality of mental health services provided in the community.
Author(s): Angela Foster, Dr Vega Zagier Roberts, Vega Zagier Roberts
Edition: 1
Publisher: Routledge
Year: 1999
Language: English
Pages: 264
Book Cover......Page 1
Half-Title......Page 2
Title......Page 3
Copyright......Page 4
Dedication......Page 5
Contents......Page 6
Figures......Page 8
Plan of the book......Page 12
Preface......Page 11
Contributors......Page 9
Confidentiality......Page 13
A note on terminology......Page 14
Acknowledgements......Page 15
List of abbreviations and terms......Page 16
Splitting, projection and projective identification......Page 20
Containment and mental health work......Page 22
Defensive care systems......Page 23
Theoretical approaches to mental illness......Page 24
New theoretical developments......Page 25
References......Page 26
A note on the internal market and the purchaser/provider split in current funding arrangements for UK mental health services......Page 27
Part I The move into the community......Page 30
1 Creatures of each other......Page 32
Institutions and institutionalization: containing madness......Page 33
The psychotic experience......Page 35
Expectations and realities......Page 37
Effects on the service......Page 38
Surviving in the market......Page 39
Reflective practice......Page 40
Conclusions......Page 41
References......Page 42
Introduction......Page 44
NIMBY and community......Page 45
The homeless and the housed......Page 46
Case studies......Page 50
Conclusion......Page 52
References......Page 53
Case study......Page 56
The beginning of the dream......Page 59
Denying the need for asylum......Page 62
Keeping the dream alive......Page 65
References......Page 66
Changing attitudes towards authority in everyday life......Page 68
Case study 1......Page 70
Case study 2......Page 71
Power, authority and leadership......Page 72
Case study 3......Page 73
Leadership, care and control......Page 75
Conclusion......Page 77
References......Page 78
Introduction......Page 80
Chaos surrounding the user in the system......Page 81
Chaos within and between workers in the system......Page 82
The consultant in the system......Page 84
Managing versus managing away: the wider system......Page 85
(b) Splitting off the community......Page 86
(c) Splitting off the carers......Page 87
References......Page 88
Part II Managing anxiety in the system......Page 90
Klein’s developmental model......Page 92
Level 1: Policy issues......Page 94
Level 2: The supervisory relationship......Page 98
Level 3: Practice implications in social work......Page 99
Conclusion......Page 100
References......Page 101
Introduction......Page 104
Residential care......Page 105
Day care......Page 107
Primary health care......Page 109
Field work......Page 111
Discussion......Page 112
Structural and organizational support......Page 113
References......Page 114
Case study......Page 116
Mistrust......Page 117
Sources of anxiety......Page 118
Defending against anxiety......Page 119
Splitting clinical and business anxiety......Page 121
Some consequences of splitting the task......Page 123
The squeeze on middle managers......Page 124
References......Page 126
Introduction......Page 128
Power and collusion......Page 129
Markets, symbolic systems and community care......Page 131
Collusion and community care......Page 132
Task-based collusion......Page 133
Heroic defence......Page 135
Discussion......Page 136
References......Page 137
Case study 1......Page 138
The system-in-the-mind......Page 140
Case study 2......Page 141
Case study 3......Page 142
Dependence, interdependence and management in community care......Page 144
Conclusion......Page 147
References......Page 148
Part III Learning from the experience of face-to-face work......Page 150
Introduction......Page 152
Clients......Page 153
Bureaucracy......Page 155
Blame......Page 156
Internal issues: multidisciplinary working......Page 157
Management and authority in the team......Page 160
Toxicity......Page 161
References......Page 162
12 Beyond keyworking......Page 164
Problems inherent in keyworking clients......Page 165
The Team Approach......Page 168
References......Page 173
Introduction......Page 176
The client and the worker......Page 177
The rationale behind the work......Page 180
Evaluation......Page 182
Conclusion......Page 184
References......Page 185
Introduction......Page 186
Community......Page 187
Quality......Page 188
The history of the group......Page 189
The role of the stafflgroup conductors......Page 190
The role of supervision......Page 191
The value of working as a group......Page 192
Use of medication......Page 194
Conclusion......Page 195
References......Page 196
Part IV Initiatives for empowerment......Page 198
Looking for the cracks......Page 200
The medical model......Page 201
The contract culture......Page 202
An alternative to the medical model?......Page 203
Planning......Page 204
Feeding back......Page 206
User/professional events......Page 207
Our role......Page 208
Conclusion......Page 209
References......Page 210
The task......Page 212
Theoretical orientation......Page 213
The membership......Page 214
The beginning: a desire to engage in the work......Page 215
The middle: anxieties that hindered the work......Page 217
Fragmentation and amputation......Page 218
The end: thinking and action......Page 219
The emergent meaning of the marketplace......Page 220
The structure......Page 222
Further developments......Page 224
References......Page 225
Case study 1: an external threat......Page 226
Case study 2: an internal threat......Page 228
Containing anxiety in organizations......Page 230
Play and the capacity to be surprised......Page 231
Case study 3: when play is not possible......Page 233
Conclusion: playing with ideas......Page 235
References......Page 236
18 From understanding to action......Page 238
Projective identification and splitting......Page 239
The self-assigned impossible task......Page 240
Some limitations of psychoanalytic understanding......Page 241
Psychoanalysis as a method......Page 242
Containment in organizations......Page 243
Learning from experience......Page 244
Some reflections on management......Page 246
Conclusion: empowerment and change......Page 249
Note......Page 250
References......Page 251
Index......Page 252
