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					BOOK REVIEWS                                                                        Jeffrey L. Geller, M.D., M.P.H., Editor

Assertive Outreach in Mental                                                              of staff, and development and deliv-
Health: A Manual for Practitioners                                                        ery of treatment. This section serves
by Tom Burns and Mike Firn; New York, Oxford                                              as a guide to the day-to-day running
University Press, 2002, 345 pages, $34 softcover                                          of a team, although it may lack the
                                                                                          specificity necessary to provide the
Jeffrey Stovall, M.D.                                                                     leaders of a team with a structure for
                                                                                          managing a large and diverse pro-

A    ssertive community treatment is
     rapidly becoming the standard
of care of persons with severe and
                                                ing model of community psychiatric
                                                nurses and the community-based
                                                primary care model around which
                                                                                          gram. The authors rely on informal
                                                                                          and flexible approaches, which may
                                                                                          stem from the years they spent
persistent mental illness who are liv-          health care delivery is organized.        working with an assertive communi-
ing in the community (1,2). Expand-             Again serving as a good introduction      ty treatment team rather than from
ed funding, training opportunities,             for readers who are less familiar         an interest in replicating or studying
and treatment guidelines in the                 with assertive community treat-           the effectiveness of a particular
United States promote assertive                 ment, this section of the text pro-       model.
community treatment as the psy-                 vides discussions of the core ele-           Burns and Firn have succeeded in
chosocial treatment of choice for               ments and structure that define as-       writing a book that serves as a manu-
persons with schizophrenia. In As-              sertive community treatment, the          al for practitioners, as the book’s title
sertive Outreach in Mental Health: A            essential role that medications play      suggests, and that utilizes their expe-
Manual for Practitioners, authors               in the treatment of serious mental        riences in a flexible approach incor-
Tom Burns and Mike Firn have                    illness, and the cultural and ethical     porating many aspects of assertive
translated a theoretical model into a           dilemmas that arise in the delivery       community treatment in the care of
practical approach for mental health            of assertive community treatment.         persons with severe and persistent
staff working in the community.                    Burns and Firn devote the main         mental illness. Although the ap-
Burns and Firn have both worked as              body of the text to the health and so-    proach is less faithful to the stricter
part of an assertive community treat-           cial care practices that are useful to    models often used in the United
ment team in the United Kingdom                 working in the community. Using a         States—both in clinical and research
since 1994 and have taken their ex-             helpful model throughout the chap-        settings—the discussions reflect dif-
periences and integrated them with              ters, they first define a problem—for     ferences seen elsewhere in assertive
standardized guidelines for assertive           example, poor adherence to pre-           community treatment between the
community treatment into this high-             scribed medication regimens—and           United States, the United Kingdom,
ly readable manual. In doing so,                then use case examples from their         and other countries in Europe (4).
these authors have written a coun-              own work to discuss methods used in          Assertive Outreach in Mental
terpoint to a more dogmatic ap-                 assertive outreach to address the         Health will provide practitioners in
proach (3) that is often used in the            problem. The authors also provide         the field with an understanding of
United States in the establishment of           brief descriptions of common psy-         the basic tenets of assertive commu-
assertive community treatment                   chiatric illnesses, which will be over-   nity treatment and will help them
teams.                                          ly simplistic for readers who have a      apply treatment in an individualized,
  The authors divide the text into              professional background but will be       flexible manner.
three sections: conceptual issues,              helpful for those beginning their
health and social care practice, and            work in the field. The intermingling      References
structural issues. The first section            of discussions of disease categories,     1. Bustillo JR, Lauriello J, Horan WP, et al:
serves as a strong introduction to              such as schizophrenia, and social            The psychosocial treatment of schizo-
anyone who is interested in learning            problems, such as managing person-           phrenia: an update. American Journal of
                                                                                             Psychiatry 158:163–175, 2001
about assertive community treat-                al finances, disrupts the continuity of
ment. Challenging the American                  the reading at times but accurately       2. Phillips SD, Burns BJ, Edgar ER, et al:
                                                                                             Moving assertive community treatment
perspective that assertive communi-             depicts the intertwined nature of ill-       into standard practice. Psychiatric Ser-
ty treatment developed uniquely in              nesses and social problems that as-          vices 52:771–779, 2001
the United States and has since                 sertive community treatment staff
                                                                                          3. Allness DJ, Knoedler WH: The PACT
been exported abroad, Burns and                 tackle and that persons with serious         Model of Community Based Treatment
Firn trace the development of as-               mental illness confront daily in the         for Persons With Severe and Persistent
sertive community treatment in the              community.                                   Mental Illnesses: A Manual for PACT
                                                                                             Start Up. Arlington, Va, National Alliance
United Kingdom to the long-stand-                  In three final brief chapters, the        for the Mentally Ill, 1998
                                                authors revisit the structure of an as-
                                                sertive outreach team, providing          4. Burns T, Fioritti A, Holloway F, et al:
Dr. Stovall is assistant professor of psychi-                                                Case management and assertive commu-
atry at the University of Massachusetts         discussions of the core elements of          nity treatment in Europe. Psychiatric
Medical School in Worcester.                    the treatment, selection and training        Services 52:631–636, 2001

PSYCHIATRIC SERVICES   ♦ ♦ November 2003 Vol. 54 No. 11                                           1549