Defining the patient level

By patient level we refer to the therapeutic domain which may include treatment,care and support for individual patients, or for groups of patients, who share common characteristics or problems, as well as interventions for the members of their wider social networks, including their families and carers. This level is traditionally considered to be the only proper territory of the clinician. As we have already argued, the practice, as well as the outcome, of clinical psychiatry strongly depends upon the characteristics of the other two geographical levels,and it is therefore important for clinicians to be aware of how processes at these higher levels may positively or negatively influence their clinical work. This may especially be the case for clinicians who tend to concentrate their attention solely upon the patient level.

The significance of the patient level

In this chapter we shall introduce the key elements (shown in Table 6.1) which are intended, when used together, to create the framework for clinical interventions at the patient level. As far as the first element is concerned, choosing the most effective clinical interventions, information on the evidence for treatments for individual patients is outside the scope of this book,and we refer the reader to the extensive relevant literature (see for example: Sartorius et al., 1993; Murray et al., 1997).