ABSTRACT
This chapter identifies some of the issues to consider in providing for the people who can present the most serious behavioural challenges, and describes the model that has developed in Manchester. It explains the experience in Manchester of establishing what has been called 'clinically managed social care'. Approaches to people presenting behavioural challenges have often been faddish. People who hurt themselves, attack others, or engage in bizarre health and safety-threatening behaviours can challenge our understanding and our abilities to work in a considered and effective way. Supervision and management of staff are essential to effectively support them in their work, but other methods are also valuable. Risk management and physical intervention were mentioned above. Risk management methods can be used to anticipate likely risks, both for service users and staff. Challenging behaviour services can become isolated from other provision very easily: different rules can begin to apply, and the result can be very damaging.
