Strategies for the management of severe psychiatric illness in the community

Abstract

Most people with severe psychiatric illness live in the community. If they are to be managed properly, services must provide an organizational method for monitoring, following up and keeping in contact with these vulnerable or disabled patients. Effective care comprises many elements of social, psychological and pharmacological management. These must be properly integrated. In this paper we discuss ways of doing this through the mechanism of the multidisciplinary team. Principles of treatment involve continuity of care, the use of key-workers, the provision of structured programmes where necessary, and the capacity of the team to reach out into the community when needed. The maintenance of perspective and morale is crucial to the good running of multidisciplinary teams dealing with the long-term mentally ill. Techniques for tailoring treatment to the individual needs of patients is described. Working in multidisciplinary teams demands a move away from traditional attitudes on the part of medical members. The potential roles of psychiatrists in multidisciplinary teams are set out.