Miroslava Janoušková
UČO: 79140
E-mail: m.janouskova@mail.muni.cz
REVIEW – časopis Sociální práce/Social work
Thornicroft, Graham; Tansella, Michele. 2009. Better mental health care. Cambridge:
Cambridge University Press, 184 p.
The book Better mental health care published in 2009 is a practical manual to develop and
provide high-quality mental health community services. The authors are experts on
community psychiatry: prof. Graham Thornicroft from the United Kingdom and prof. Michele
Tansella from Italy. Thornicroft and Tansella develop a clear structure of argument based on
geographical location and time processes in mental health policy. They call it the “matrix
model” (p. 2). According to this model, issues of mental health care are divided into three
levels: country (national), local and individual. "Time" refers to the three phases of policy:
inputs, processes, and outcomes.
The authors describe ethical foundations of care and how to put them into the practice at
the national, local and individual level. The main principles are: autonomy, continuity,
effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and
efficiency. The authors further present evidence-based approaches. Finally, they emphasize
the importance of knowledge and experience from across the world in establishing mental
health care. The chapter presents examples and advices from professionals from 25
countries (e.g. how to manage opposition within the mental health system or how to deal
with boundaries and barriers in community care and how to negotiate them in multidisciplinary
teams). The authors propose a balanced approach which includes community
care with a limited provision of hospital care. They discuss resources and in particular the
lack of resources outside of the health (hospital) care. As a solution, they recommend a
transfer of resources from hospital to community services. They refuse to build separate
services, community and hospital. The moving from institutions to community is, in the
authors' view, not only “a physical relocation of treatment sites" but also "a fundamental
reorientation of perspective” (p. 153) requiring new staff attitudes and specific training.
The chapter entitled "The Central Role of Staff for Better Mental Health Care" (p. 153) is a
practical guide addressed to social workers, therapists, educators and trainers in the field of
community care. The authors refer to changing roles of professionals in mental health care.
They also compare institutional and community perspective in both staff attitudes and staff
training. The chapter explains how to implement guidelines in practice and how to build and
maintain clinical teams. The whole book offers a specific model of how to establish, develop
and evaluate community mental health services. The model is based on Western European
tradition with additional worldwide experiences.
If we compare this book with similar ones published in the Czech Republic, we can state that
Czech handbooks for mental health care are focused rather on practical aspects of direct
social work. Probstová (2005) presents various attitudes and guidelines on how social
workers can approach clients with mental illness and also describes community care.
Mahrová and Venglářová (2008) provide broader texts on social work and psychiatric
diagnoses. The space for mental health care is limited to a few chapters aimed at how to
work with specific groups of clients (e. g. elderly, children, addicted persons or psychotics).
The aforementioned Czech books are directed mostly at social workers and specific
practices. In contrast, Thornicroft and Tansella (2009) intended their book for a broader
audience. Their book can bring important knowledge to both social policy makers and social
work professionals. However, it can be helpful also for educational institutions in the area of
community care. This is a very useful book specifically for Czech mental health care that
lacks a formal policy conception.
References:
MAHROVÁ, G., VENGLÁŘOVÁ M. a kol. 2008. Sociální práce s lidmi s duševním onemocněním. Praha:
Grada Publishing.
PROBSTOVÁ, V. 2005. Sociální práce s duševně nemocnými. In MATOUŠEK, O., KOLÁČKOVÁ, J.,
KODYMOVÁ, P. eds. 2005. Sociální práce v praxi: specifika různých cílových skupin a práce s nimi.
Praha: Portál, p. 133-161.