Brief Treatment and Crisis Intervention Advance Access originally published online on March 30, 2006
Brief Treatment and Crisis Intervention 2006 6(2):175-176; doi:10.1093/brief-treatment/mhj015
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Book Review |
Handbook of Community-Based Clinical Practice
Retired Associate Professor of Social Work, National Catholic School of Social Services, Catholic University of America, Washington, DC
eplionis{at}aol.com
Anita Lightburn and Phebe Sessions (Eds.). Handbook of Community-Based Clinical Practice. New York: Oxford, 2006. 561 pp. ISBN 13 978-0-19-515922-6, $65.00 (hardcover).
This is a book about transforming the delivery of public mental health services. It sets the bar of service delivery at building communities that promote resilience and support recovery as opposed to setting the bar at symptom management and living with long-term disability.
The Community Mental Health Centers Act moved public mental health service delivery from institutional care to community care. The history of service delivery to deinstitutionalized populations leaves much to be desired. Communities have not always been receptive to or supportive of such populations. Services have been underfunded, understaffed, and sporadic. According to the authors, the World Health Organization ranks mental illness first among illnesses that cause disability creating a major unrecognized public health burden. The authors note that over 50% of community-based mental health services are currently based on a medical model where services are delivered by multidisciplinary experts located in neighborhood clinics. Such models fail to reach those not likely to use traditional mental health services, and such models do not develop communities as safe havens, rich in protective factors.
Consistent with a public health model and recommendations from the New Freedom Commission on Mental Health 2003, Lightburn and Sessions have edited and contributed to a handbook designed to promote transformation of the delivery of public mental health services. The book emphasizes programs designed for prevention and early intervention. Specifically included are programs on early childhood development, family support centers, school-based mental health programs, and systems of care for children and adolescents. The book also includes community-based primary care programs (acute mental health) and programs for adults and seniors. Contributors subscribe to system of care principles based on partnerships with consumers, families, and natural helpers. Proposed new systems of delivery are based on a strengths perspective and empowerment approaches.
The book is divided into four sections. Section 1 compares and contrasts traditional models of service delivery with the proposed transformative models. Section 2 has 10 chapters that focus on paradigm shifts, ideas of community, and cultural competence. Section 3 devotes four chapters to leadership, policy, and program innovations. Section 4 provides practice examples in four areas: early intervention and family support, school-based practice, community-based mental health services for children and families, and community mental health for adults. The works of Hartman and Laird and structural strategic family therapists are carried forward in the section on family support programs. Readers will readily recognize the names of many contributors such as Ann Weick, Dennis Saleeby, Lynn Hoffman, and Catherine Nye to name a few.
Ideologically committed to a strengths and empowerment perspective, the book is somewhat unbalanced in its presentation of the biological realities of mental illness. Medication to manage symptoms is a reality and compliance with medications is a major factor in the success of community-based clinical practice. The emphasis on recovery at the expense of symptom management and living with a long-term disability stretches credulity. The authors claim that knowledge of trauma is a key competency in the delivery of community public mental health services but leave unaddressed knowledge of other causes, forms, and treatments of mental illness. Nonetheless, the book identifies the issues associated with the delivery of public mental health services and offers some innovative alternatives to existing approaches. With a diminishing workforce, community-based mental health practice is at a crossroad. This book breathes life and hope back into community-based mental health practice.
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