The Role of Training in Targeting Severe Mental Illness

Abstract

Concerns have been raised in numerous inquiries and investigations about the effectiveness of services in meeting the challenge of risk management. Examples of catastrophic systems failures can be recited in a distressing litany of preventable homicides or suicides, achieving sensational coverage in the media and, perhaps, disproportionate influence at the level of government. Since the publication in 1994 of the inquiry report into the case of Christopher Clunis, a pivotal event in the history of UK mental health services, over 80 similar inquiries have been undertaken (Howlett, 2000). A number of authors have attempted to collate and review the various themes and recommendations of this welter of scrutiny into service failings (see Shepherd, 1996; Reed, 1997), aiming to elucidate further the main lessons which ought to be drawn. Howlett (2000) bemoans the fact that most of these inquiries are of national interest, but remain grounded in parochial systems of dissemination. He points out that there is no statutory mechanism for insisting upon widespread recognition and implementation of the key findings. However, the high profile afforded such inquiries has a corollary in a powerful and enduring lay stereotype equating all mental distress with a propensity toward violence and threat. Consequently, practitioners have to attempt the delivery of care sensitive to the expressed needs of service users against a policy backdrop which, at least at the level of rhetoric, is increasingly drawn toward tighter social control.

This chapter will discuss the notion of targeting in the context of training those who provide care for individuals with serious and enduring mental health problems and are deemed to be especially vulnerable or dangerous.