Managing Mental Health Care in the Community: Chaos and Containment

Managing Mental Health Care in the Community: Chaos and Containment

Managing Mental Health Care in the Community: Chaos and Containment

Managing Mental Health Care in the Community: Chaos and Containment


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.


This book is aimed at all practitioners, managers, policy-makers and students who have an interest in developing good practice in community care. Although it draws mainly on experiences in the mental health field, we believe that the problems and dynamics described will be recognizable and relevant to people working in other areas of community care.

There are many excellent books on community care. in the main, these focus on policies and procedures, either suggesting ‘how to’ improve services and plug gaps, or arguing for or against community care. Here we try to examine the actual experience of the chaos and anxiety in the system, and different attempts to manage these, using psychoanalytic and systems theory to make sense of experience, and numerous case studies to illustrate these ideas.

While the case examples, legislation and contracting arrangements referred to in the book are British, the problems, challenges and dynamics described are similar to those in many other countries seeking to provide care in the community which was, until recently, provided mainly in institutions. the core challenges are, first, to create systems of care that can contain need, dependence and disturbance within the unbounded and multifaceted setting of a community; and second, to maintain these systems as healthy structures in which it is possible to engage openly with clients and to think about the work without being overwhelmed by chaos and contaminated by destructiveness and despair. the additional difficulty of providing adequate care within ever-tightening financial constraints is also common to countries outside the United Kingdom.

In order to meet these challenges, we need to provide ourselves with a reflective space in which to examine the nature of the relationships between different parts of our care systems, and to work with the actual and potential chaos within and between these subsystems, at the same time as recognizing that—given the nature of mental disturbance and the nature of organizations—chaos will always be present. in this book, we invite readers to share with us a series of explorations of systems of care. We hope that it will provide support in thinking about their difficult and often very painful

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