An evaluation of a community rehabilitation team

Abstract

Contemporary specialist mental health policy in Britain emphasises the development of teams dedicated to specific functions such as assertive outreach, crisis management and home treatment. Less attention is devoted to alternative approaches that may augment the illness-oriented perspective of existing specialist policy. This paper describes the rationale and working practices of a community rehabilitation team (CRT) whose work is predicated on the delivery of psychosocial interventions to enhance community integration. A naturalistic design was employed to describe the service in terms of its rationale and target client group, client characteristics, functions performed and interventions offered, and client perceptions of the team. A census of clients referred to the service during its first 12 months of operation was recruited for the study, as were all clinical staff. Data collection methods included surveying client records and case notes, and conducting semi-structured interviews with staff and clients. The findings indicate a team whose interventions are oriented toward optimising levels of independent functioning and promoting social integration through the use of ordinary community resources. Although these specialist functions were evident in the data their delivery within a climate of generic case management created specific tensions for the team. The nature of these tensions is explored in relation to contemporary policy and a case is made for the incorporation of specialist rehabilitation in the current quest for functional services.