Managing Transitions to the Community

To the Editor: An article in the November 2004 issue, "Principles for Managing Transitions in Behavioral Health Services" (1), summarized a document developed by the American Association of Community Psychiatrists (AACP). Our question is, Where is the community?

Although the AACP's principles note system fragmentation and organizational self-interest, they lack a community perspective, and they patronize nonpsychiatric professionals and consumers. The authors state that social workers have "carried the bulk of responsibility for developing transition plans." However, they mischaracterize social work education as "limited primarily to field placement and thereby … most heavily influenced by prevailing practices." In reality, key features of master's-level social work education include knowledge of the psychosocial dynamics of well-being, skill in using the social work process from engagement through transition, and knowledge of evidence-based research on which to build effective programs and practices. Transitions and their ramifications are fully addressed in the social work code of ethics (2), often the first document that social work students are asked to review.

Of greater concern is AACP's ambivalent message to consumers. Although the authors note that transitions are to be "client driven," they also state that "persons in transition should not be expected to assume responsibility to manage the complex and multifaceted aspects of their continuing care." In today's managed care world, clients are being asked to do just that, and professionals must support their efforts to do so.

The article on AACP's principles ignores the many collaborating professions and stakeholders whose participation is essential in promoting community mental health. A statement of principles that disregards and denigrates those contributions is hardly helpful.

Ms. Ralph is field consultant and lecturer and Dr. Terrell is coordinator of academic programs in the School of Social Welfare at the University of California, Berkeley. Ms. Ralph is also the representative of Region XIII (Calif.) on the board of the National Association of Social Workers.