Abstract
This book is a must for anyone who is interested in community-based approaches to mental health and substance abuse issues.
This edition is a recent update (and now in paperback) of its hardback original (2005). It describes a very specific approach to working with young people and families. The main feature of these families is that the young people are on the verge of being placed either in a social care setting or a young offender institution. Multisystemic therapy (MST) is a community-based approach of working with families to help them reduce the high level, and often myriad, of concerns that put the adolescent at risk of being placed outside of the home. It is a manualised treatment model (described in Henggeler et al., 2009) that has been designed to empower families and put the parents more in the driving seat in relation to their families. In Multisystemic Therapy and Neighborhood Partnerships: Reducing Adolescent Violence and Substance Abuse the authors describe the approach and how they have taken the MST approach and applied it to an entire community in Charleston, SC, USA. They set the scene by describing a reality of substance misuse children and adolescents, parents who are out of control, living in poverty, where distrust of professionals has taken over and the community as a whole do not feel safe and secure with each other. Many professionals have made attempts at addressing the problems, but these have either been unsuccessful or, when progress had been made, it has not been maintained.
MST as a treatment model is very clear about the expectations and responsibilities of clinicians and the supervisor. The families are the central focus of the work but not the only one. An important feature of the work is to strengthen (or, if required, find and mobilise) the so-called ‘natural ecology’ of the family to ensure that the parents in particular become responsible for their own problems, but more importantly become responsible for the solutions as well.
The book itself uses very clear language and is easy to follow. Each chapter is well laid out. The book is structured in three parts. After a brief introduction the first part describes ‘the empirical and clinical background for the Neighborhood Solutions Project’. The authors describe in a detailed fashion how the Project came about and tell a compelling story that does not leave out the challenges of trying to engage with an entire community or neighbourhood in an attempt to change families. One reads about how ‘community leaders’ were identified and approached and how trust needed to be gained at the various levels as part of the MST framework, i.e. individual, family, school, peers and community. MST has had a lot of success implementing the MST model in many states in the USA and also in many countries in Northern Europe, such as Finland, Denmark, the Netherlands and recently in the United Kingdom (see, e.g., http://www.mstservices.com):
“Communities that experience economic disadvantage, however, must have proof that outsiders are not coming in to take from the community and give little in return. That is, researchers cannot expect to be welcome to conduct research, for research’s sake. There must be a substantial benefit for the community, and that benefit must meet the goals and desires of the people. Leaders must feel comfortable that the research collaborators, are committed to helping meet the goals specified by neighborhood residents and that the researchers are not planning to ‘hoodwink’ the neighborhood” (p. 69).
I am reminded of an interview with Dr Alan Cooklin when asked about the topic of engagement with clients from other ethnic backgrounds or those of a different race, replied: “I start from the vantage point that they do not have any reason to trust me” (Karamat Ali, 2003). Just as Dr Cooklin assumes that it is very likely that a group of people have experienced racial discrimination, and hence are likely to initially distrust white professionals, one could assume that some families from certain areas have experienced discrimination and marginalisation based on class resulting in a more suspicious stance towards often middle class professionals, or at least towards people from outside their community.
There are two chapters by invited contributors which consider neighbourhood-based services (health and law, respectively). The implications for the entire approach to mental health prevention and treatment have a close connection to the community psychology ethos. The models are ecological and despite the emphasis in the literature on so-called treatment, prevention is of high importance. The standard MST approach is to try and prevent further family breakdown. In this book the Neighborhood Project show us an even more comprehensive ecological approach. The approach targets young people who display anti-social behaviours, in the family home and in the wider community that they are part of. Formal CAMHS settings are also reflecting on their approach and various suggestions are being made to restructure existing or create structures more conducive to the emerging agenda of making the services more relevant and responsive to those with mental health needs (e.g. Asen and Bevington, 2007). The final chapter consider funding implications for such a community-based approach.
I recommend this book to clinicians and researchers, as well as managers and policy makers. It could be read as an example of an evidence-based attempt at trying to work with the most hard to engage young people from families in often very long-standing and desperate situations. Whether MST will be part of a ‘dissemination of innovation’ (Mayer and Davidson, 2000) depends in part on the success of the current national research pilot that is being undertaken in England. In the meantime, this book remains an interesting read as an example to strengthen relationships within families as well as those with wider systems.