ABSTRACT
Psychosocial interventions (e.g. behavioural family therapy, relapse prevention, psychoeducation and cognitive-behaviour therapy) for psychosis have received increasing attention and support for adoption into routine practice in recent years. Cognitive-behaviour therapy (CBT) for psychosis, for example, is now part of standard evidence-based practice, both in research and clinical arenas and latterly in government guidelines in the United Kingdom (National Institute for Clinical Excellence, 2002; National Institute for Health and Clinical Excellence, 2009). The focus of these interventions has often been on the reduction of symptoms and distress or the prevention of psychotic relapse. A large number of randomised controlled trials have, however, failed to show consistent evidence of sustained clinical outcomes (Jones et al., 2002; Wykes et al., 2007; Lynch et al., 2010). The reality is that many people’s psychotic symptoms and associated beliefs remain treatment resistant even to CBT and they continue to be cared for in long-term settings, by Multidisciplinary Teams (MDTs) where the emphasis is often on minimising risk. Perhaps surprisingly, much less attention has typically been paid to the multidisciplinary treatment and management of these clients who exhibit problematic or risk behaviours. This is in spite of the fact that behaviours such as aggression are a common issue in psychiatric inpatient treatment (Daffern et al., 2004, 2007) and in the community (Swanson et al., 1990; Monahan et al., 2001). Individuals with psychotic disorders such as schizophrenia are also at greater risk of suicide (Pompili et al., 2007) and selfneglect (ReThink, 2004). Furthermore, such behaviours may severely limit the individual’s independence and freedom, significantly reducing their opportunities for community living and decreasing their quality of life. In this book we outline an innovative approach to the assessment and management of problematic and risk behaviours in psychosis. We term this the Shared Assessment, Formulation and Education (SAFE) approach. Our primary focus is on achieving integrated MDT working, aimed at eliciting changes in the client’s problematic or risk behaviours, whilst concurrently
promoting a reduction in distress. It is a collaborative process that values all perspectives and serves to normalise problematic behaviours, making them understandable through the use of shared formulation processes. SAFE aims to also increase staff1 and carer empathy and promote shared effective care for managing such behaviours. Ultimately, our goal is to maximise the individual’s independence by reducing barriers to living an ordinary life that problematic and risk behaviours can create and thereby enabling opportunities for recovery.
