Adaptive Mentalization-Based Integrative Treatment A Guide for Teams to Develop Systems of Care

Socially excluded youth with mental health problems and co-occurring difficulties (e.g. conduct disorder, family breakdown, homelessness, substance use, exploitation, educational failure) attract the involvement of multiple agencies. Poorly coordinated interventions often multiply in the face of such problems, so that a young person or family is approached by multiple workers from different agencies working towards different goals and using different treatment models; these are often overwhelming and may actually be experienced as aversive by the young person or their family. Failure to provide effective help is costly throughout life This is the first book to describe Adaptive Mentalization-Based Integrative Treatment (AMBIT). This is an approach to working with people - particularly young people and young adults - whose lives are often chaotic and risky, and whose problems are not limited to one domain. In addition to mental health problems, they may have problems with care arrangements, education or employment, exploitation, substance misuse, offending behaviours, and gang affiliations; if these problems are all occurring simultaneously, any progress in one area is easily undermined by harms still occurring in another. AMBIT has been designed by and for community teams from Mental Health, Social Care, Youth work, or that may be purposefully multi-disciplinary/multi-agency. It emphasises the need to strengthen integration in the complex networks that tend to gather around such clients, minimising the likelihood of an experience of care that is aversive. AMBIT uses well evidenced 'Mentalization-based' approaches, that are at their core integrative - drawing on recent advances in neuroscience, psycho-analytic, social cognitive, and systemic "treatment models".

Dickon Bevington is a Consultant in Child and Adolescent Psychiatry in the NHS in Cambridgeshire, and is Medical Director at the Anna Freud National Centre for Children and Families. He specialises in the outreach treatment of complex, risky and hard to reach young people with substance use disorders and has previously worked in Adolescent inpatient hospitals. He has led the development of online wikis as treatment manuals, and previous publications include co-authorship of "What Works for Whom? A critical review of treatments for children and adolescents" (Fonagy et al, Guilford, 2014). Peter Fuggle is a clinical psychologist and currently Clinical Director of the Anna Freud National Centre for Children and Families. He previously worked for over 30 years in the UK National Health Service integrating mental health services for children and young people into schools and social care. He has a long standing interest in working on projects for young people and families who do not seek help for their mental health needs and the AMBIT collaboration arose directly out of this interest. Liz Cracknell is Programme Lead for AMBIT at the Anna Freud National Centre for Children and Families. As a Mental Health Nurse and Systemic Practitioner, she leads an integrated NHS health team that in-reaches to a Secure Children's Home. In her clinical role, Liz has specialised in work with young people with complex, risky problems, utilising the AMBIT approach. She has contributed to a number of key publications and the development of AMBIT and has trained and consulted with hundreds of workers in AMBIT in the UK and internationally. Peter Fonagy, OBE FMedSci FBA FAcSS PhD is Professor of Contemporary Psychoanalysis and Developmental Science, and Head of the Division of Psychology and Language Sciences at UCL, and Chief Executive of the Anna Freud National Centre for Children and Families. His clinical and research interests centre on issues of early attachment relationships, social co