ABSTRACT
Mental health practice has emerged from a medical model of explanation and treatment, with an illness management paradigm that guides service commissioning, planning and practice/delivery. Patients, clients or users are treated and their illnesses cured or managed. This conceptualisation of mental health determines the locus of control (Zimbardo 1985) to be within the individual, which places responsibility on the user of the service for the illness, and the cure. Meanwhile, significant others of the user observe hopefully that the cure will take place and the patient will ‘get better’. When referred to mental health services, the responsibility can be placed on (and felt by) the clinician to alleviate the user’s mental health problem. This could be one of the reasons why, at times, it is difficult in child and adolescent mental health services (CAMHS) to discharge the user as clinicians strive to ‘cure’. In CAMHS the importance of significant adults, particularly the family, is recognised, due to the explicit dependency of minors on them. Multidisciplinary psychological therapy approaches, including systemic and narrative therapy approaches, are common treatment modalities provided within child and adolescent mental health services across the United Kingdom that can attend to these influences. The overriding approach remains to treat individuals, however, even though the influence of the family, the school and peer group environment is recognised.
