Locality Services in Mental Health. Developing Home Treatment and Assertive Outreach. Edited by H. Wood & S. Carr. London: The Sainsbury Centre for Mental Health. 1998. £15.00. ISBN: 1-870480-40-6.

This manual describes the reconfiguration of North Birmingham Mental Health Trust Locality Services. It gives an account of how services were “set up, run and sustained”, with the intention of helping others “replicate the successes and avoid the pitfalls”. It has an innovative layout, being presented as a pack of five removable booklets, each with a different emphasis.

The manual gives a good description of how the original locality services were evaluated, including desired areas for change. It gives a clear account of the proposed locality system. Community mental health teams are abandoned in favour of primary care mental health teams, with the addition of a home-based treatment team and assertive outreach team. The emphasis of the services described is on offering safe alternatives to hospital admission.

The booklets give clear accounts of how the teams were set up, from defining the services, operational policies and target populations, to recruitment, team skill mix and size, training and induction and daily functioning. There are also sections on ‘a day in the life of’, giving staff, user and carer perspectives. Advice on managing the process of change and the resistance to it is included, with offered project management strategies and worksheets to guide through the process of service development. Concise summaries of the evidence base for assertive outreach and home treatment and the model ingredients offer practitioners a ready reference. Funding for the development of the described homebased services was released by the delay of a replacement in-patient unit, with a resultant reduction in bed numbers. The authors acknowledge that additional funding provided by the Sainsbury Centre for Mental Health ‘pump primed’ the pilot scheme. Great effort was made to ensure the pilot project succeeded, owing to local scepticism that a reduction in bed usage could be achieved and sustained. A Sainsbury Centre for Mental Health evaluation of the home treatment team suggests that there was a 40% reduction in occupied bed days in 3 years. How much this was a result of the enthusiasm, hard work and gate-keeping to the in-patient unit of the home treatment team, rather than the intervention itself, is unclear.

In summary, this manual is comprehensive and well set out and has a lot to offer those developing local mental health services. It shows North Birmingham Mental Health Services in a glowing light. However, such optimism and enthusiasm may generate antibodies in some people whom, without such resources and clear guidance from the Sainsbury Centre, may find replication of these services unrealistic.