Assertive outreach practitioners will be drawn to a new British publication on this topic, but they may be puzzled by its subheading: A Strengths Approach to Policy and Practice. The strengths model attracts relatively little direct acknowledgement in psychiatry, being more a set of values than a fully pragmatic clinical or service model. Whereas many who talk of hope, creativity, holistic care and neighbourhoods rarely move beyond the nebulous, the authors do present a structured, relevant and intelligent guide to developing services and practices that are built on service user-led wants and aspirations, rather than merely service-generated concepts of social inclusion and recovery.
The book supplies a critique of conventional approaches to serious mental illness as focusing on pathology, problems and deficits, with an overall therapeutic nihilism. The strengths view does not deny the existence of difficulties and sees them as obstacles to be overcome on the way to self-defined goals. With an unashamedly optimistic view of human interaction, the pure strengths model practitioners will have their faith tested in working with hard-to-engage assertive outreach clients in the prevailing atmosphere of risk avoidance. Defensive practice is challenged as limiting the individual’s ability to weigh up the benefits and harms of available options, and to experience autonomy. Assertive outreach, with greater resources from small case-loads, is a model that sits well with delivering best practice. With its long-term approach, it is also a model for engaging people meaningfully, including allowing individuals to take control of decisions in lifestyle choice, accommodation or relapse responses and to facilitate learning from successes and failures. Ethical dilemmas are well covered in a separate chapter.
Evidence for greater optimism is drawn from longitudinal studies of major mental illness, first person accounts and effective collaborative therapeutic interventions such as cognitive-behavioural therapy and motivational interviewing for substance misuse. Throughout there is good use of case studies and summary boxes, and chapters are clearly structured. However, the style of applying the benevolent strengths ‘faith’ to all aspects of care and service organisation will not be to everyone’s taste.
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