Mental health policy and practice
International Journal of Integrated Care, 30 May 2007 - ISSN 1568-4156
Book review
Mental health policy and practice
Helen Lester and Jon Glasby
Basingstoke, Palgrave Macmillan: 2006, pp 260,
ISBN 978 1 4039 3543 4
Christina van der Feltz, Psychiatrist-epidemiologist

This 260 page book, written by experts in the field, is meant to educate college students as well as professionals and policy makers in public mental health issues. It seems to focus especially on students, as each of the chapters concludes with exercises and suggestions for further reading.

The book provides a well documented basic overview of the main developments and dilemmas in the field. It contains eleven chapters, the first sketching conceptualisations of mental illness and public health issues over time, especially the divide between the medical model and the social causation model developed in antipsychiatry. The second chapter resumes developments in policy making on strategies to contain mental illness in the community. Whereas at first so-called lunatics were not excluded from society, in the eighteenth century asylums were built and the number of admissions rose to great heights; de-institutionalisation and community based treatment were modern developments for patients with mental illness.

After this historical and conceptual overview, the authors sketch several prime fields of interest for the management of mental illness in the community, such as the chapter on the primary care setting, in which consultation liaison models for cooperation between General Practitioners and psychiatrists are described; Active Community Treatment models in the community setting; and the mental health and forensic mental health institutional settings. In the chapter on partnership working, that describes barriers to collaboration between diverse care professionals and institutions as well as community institutions, it is remarkable that the disease management model is not discussed as an option, as its approach to combine evidence based prevention and treatment as well as organisation of care can be of great merit to overcome the problems of organisation and integration of care. Other chapters include the patient's and the caregiver's perspective; here the concept of emancipation of the patient by empowerment should have been warranted a prominent place as a way to overcome stigmatisation and barriers to access to care.

In the concluding chapter, the authors discuss how they gave an overview of the problems that exist in implementing a well functioning public mental health system. They attribute the fact that these problems have not yet been solved to the fact that many stakeholders have different views on mental illness and the way mental health care should be provided, but they do not seem to have a vision aiming at addressing this problem. In the introduction they stated that they did not want to do so, as they wanted to give a non-biased overview. This is of course a good principle. However, in the end one remains wondering if the overview does not become somewhat pessimistic this way. Many initiatives, such as the development of multidisciplinary guidelines, disease management models, European initiatives to implement community based recognition and treatment programs attacking mental illness, and new developments in prevention, destigmatisation programs and patient empowerment would have deserved a more prominent place in this book.

As it is now, this book is a good read for a student or any person in need of a quick basic overview of Public Mental Health issues from a British perspective. It has special value in terms of providing background information and data on the subject, as it is thoroughly documented, but it is not a visionary book. A person interested in groundbreaking work focussing at attempts to integrated care for the mentally ill would have to look elsewhere.