In recent years the practice of psychiatry has changed fundamentally. Mentally ill people have been moved out of the large institutions, with their clear structures and hierarchies, and into the community. This shift has required the development of new service structures, new facilities, new attitudes and new professional relationships. This book provides the first authoritative, international review of community psychiatry, taking into consideration theoretical as well as clinical issues. The key aim of the book is to review the status of community psychiatry throughout the developed world, presenting a comprehensive and critical exposition of the achievements, limitations and dilemmas in the theoretical base and the practical implementation of a community-based strategy. The book covers the available evidence base, gaps in that evidence base and describes, where possible, best practice for treatment and care. Current areas of theoretical and professional conflict are also covered. There are two main sections of the book; the first describes psychiatry for the community, in which the population needs for psychiatric care are considered. The second major section examines psychiatry in the community, describing how the service systems are designed to meet these needs. The final section of the book examines ethical issues and dilemmas. With 46 chapters from the leading international experts in the field, this book will be essential reading for all those working with the mentally ill in the 21st century.
What is community psychiatry?,
Szmukler and ThornicroftI: Psychiatry for the Community: the Conceptual and Scientific Background
Defining 'community': meanings and ideologies, Ramon
Scientific Background
Epidemiological methods, Lewis, Thomas, Cannon and Jones
Methods for evaluating community treatments, Tyrer
Methods for evaluating community services
Defining the Extent and Impact of Mental Disorders
Mental disorder and disability in the population, Jenkins and Singh
The needs of patients with mental disorders, Slade and Glover
The costs of mental disorder, Knapp
The impact of mental disorders on families and carers, Lefley
II: Psychiatry in the Community: the Service System
Balancing clinical values and finite resources, Holloway
The planning process for mental health services, Thornicroft and Tansella
Services responses to cultural diversity, Minas
Integration of Components into a System of Care
Sectorisation, Hansson
Balancing the service elements, Burns
Generic versus specialist mental health teams, Burns
Training for competence, Gournay
Service Components
Emergency psychiatric services, Breslow
Outpatient psychiatric services, Becker
Partial hospitalisation, Schene
Day care and occupation, Rosen and Barfoot
Residential care, Shepherd and Murray
Inpatient treatment, Szmukler and Holloway
Boundaries with Specialist Mental Health Services
Drug and alcohol services, Ridgely and Johnson
Psychotherapies, Holmes
Services for older adults, Banerjee
Community mental health services for adults with learning disabilities, Bouras and Holt
Interfaces between Mental Health Services and the Wider Community
Social welfare services, Carpenter and Barnes
Community alliances, Grey
Responding to migration and upheaval, Mollica
Community attitudes towards mental disorder, Warner
Users and Carers as Partners
Carers and carer organisations, Leggatt
The Preventative Approach
Secondary prevention of mental disorders, McGorry
Tertiary prevention of mental disorders, Gittelman
III: Ethical Issues and Dilemmas
Treatment pressures, coercion and compulsion, Szmukler and Appelbaum
Privacy and confidentiality, Backlar
Glossary