Managing mental health in the community

Chaos and containment

Edited by Angela Foster and Vega Zagier Roberts Routledge 264 pages£16.99

The government set out its vision for mental health services in a major policy statement at the end of 1998. With a national service framework and a review of the Mental Health Act, debate and discussion is set to continue through this year and into the new century.

With the government claiming that 'community care has failed', all these often heated debates will return to the question of how and why past changes - from hospital to community - have resulted in perceived failure, and how policy makers, managers and practitioners might avoid these difficulties in future.

Managing Mental Health in the Community tackles the current practice and policy debates and is one of a number of texts which set out to explore aspects of managing and working in community mental healthcare.

It is aimed at practitioners, managers, policy makers and students and defines its purpose as the exploration of 'actual experience' of chaos in the mental health system.

The book is divided into four parts. Contributors, including practitioners, academics, psychotherapists and managers, examine the move from institutional to community-based care, before looking at anxieties about managing the system.

The third section takes the perspective of those working in direct practice with people with mental illness. Finally, the book examines how alternative ways of involving service users and of engaging frontline staff in the development and management of services can improve mental healthcare for service users and create a system in which staff are able to work more effectively.

Contributors write from psychoanalytically informed perspectives and the book applies psychoanalytic theories to the mental health system and how it can be improved.

It works from the belief that current difficulties arise from unwillingness or inability to examine the nature and purpose of community care policies and how they are implemented.

It argues that the chaos and anxieties experienced by people with mental illness also affect staff, for whom an absence of sufficient time for reflection will cause continued stress and difficulty.

The book is helpful in that it offers some challenging perspectives on the nature of community care and present-day problems, as well as suggesting how good practice may be developed.

Certainly, there is strength in considering current problems from the perspective of staff working face-to-face with service users.

However, some in the target audience who are unfamiliar with the application of psychoanalytic thinking to community care may find the text rather hard going.

Others may be deterred by a psychoanalytic approach that seeks to explain all of the problems arising in the mental healthcare system.

Angela Greatley

Senior project manager mental health, King's Fund.