Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units is a welcome addition in a time when guidelines and recommendations from The Department of Health to the Sainsbury Centre are regularly recommending an increase in the amount and variety of therapeutic activities on acute inpatient units. Organizations representing the views of service users (e.g. Mind) regularly deplore the therapeutic options available to inpatients, which for many are limited to options falling within the remit of the medical model. An excellent point made by the authors is that currently every inpatient has access to medication, while access to a CBT based approach, which has an equal and in some cases better evidence base, is very limited. Although this book is not a treatment manual, it broadly covers the issues and challenges one might come across in trying to bring CBT onto acute wards, from resistance on the part of the client to working within a ward with high levels of acuity.

Anyone raising this topic is likely to encounter a response that questions the appropriateness of CBT in such a setting for a myriad of reasons, which is tackled head on in the initial section of the book. This section dispels myths such as it is too difficult for ward staff to implement CBT in such an environment, that CBT is recommended for longer periods of time than a typical inpatient stay, CBT will not address problems such as homelessness, unemployment and, most commonly of all, that inpatients are in crisis and cannot benefit from CBT. Alongside the chapter dedicated to this, sprinkled throughout the book are many examples of how such difficulties were overcome, most often drawing from the personal experiences of the authors, many of which are easy to identify with.

The book moves on to more practical topics such as how to approach a case in an acute setting, with special emphasis on formulating what the dynamics of the ward environment means for an individual. A cross-diagnostic approach to working with people in crisis is recommended, in particular the Interacting Cognitive Subsystems (ICS) model, but a more detailed explanation of the model itself would have made its application clearer. This, in particular, is recommended for those following mindfulness or other “third wave” approaches. Through several case examples, the authors take us through working with overwhelming emotions, psychosis, depression, suicidality, and personality disorders. Although a large proportion of work on wards revolves around psychosis, the authors do not fail to include broader matters such as self harm, working on PICUs or working on low self esteem. Group work is given special emphasis, as groups not only give us a chance to work with multiple clients but also to work with other mental health professionals, hence giving the opportunity to simultaneously provide CBT while also training co-facilitators.

Of course psychologists in the present mental health system cannot be on inpatient wards as much as they need to be, so others such as nurses or occupational therapists need to be able to provide this. Therefore, psychologists must work with ward staff to build a therapeutic culture. Reflective Practice, or the critical analysis of everyday working practices with the goal of improvement, is increasingly popular as a way of improving services and presented as an example. How ward staff can learn to provide CBT, the challenges for both individuals as well as the ward itself, are all discussed, as is the need for strong supportive management at ward as well as trust level. It is proposed that a “critical mass” of staff become able to provide CBT in order to change the culture on the ward and increase the likelihood that such skills are used.

The book draws to a close by examining some of the challenges in evaluating such a service, and concludes with a plea for expanding the evidence base for CBT in acute settings, acknowledging that lack of evidence is currently one of the biggest obstacles we face, especially at the commissioning level. Overall, this book draws together the voices of clinical and research psychologists, nurses, occupational therapists and service users in a practical and enthusiastic guide to the successes, challenges and realities of CBT in such a setting. For anyone contemplating or already trying to bring CBT to inpatient settings, this book is an invaluable resource.