Modern Community Mental Health: An Interdisciplinary Approach

The book Modern Community Mental Health is an ambitious project. The editors inform the reader that they present 37 original chapters by an interdisciplinary cohort of leaders in the field of mental health to provide the “best knowledge within a realistic format to inform a current model of community mental health practices.” How did they do?

The four editors are well equipped for the task. Their joint experience in the field is well over 150 years. They have lived through, if not informed, the development of a good deal of what Modern Community Mental Health covers.

The authors are indeed an interdisciplinary group of experts—by my unduplicated count, they include 29 physicians, most of whom are psychiatrists; 13 individuals in the rehabilitation field; 13 administrators; nine psychologists; nine in the social work field; four in nursing; four in the legal arena; and two doctoral candidates. Of that group, four have law degrees and a few are self-proclaimed “prosumers.”

The 37 chapters range from sound to excellent contributions to the field. Each stands alone very well. For those familiar with the field, the chapters don’t cover much new ground, but that is in line with an edited volume of this kind.

So far, so good. The downfall is that the chapters don’t fit together as a book. And for this failing I hold the publisher responsible.

First, the book has four sections: “Community Mental Health: Progress and Principles,” “Preparation for Public and Community Work,” “Best Practices and Current Evidence for Clinical Practice,” and “Leadership, Administration, Management.” Some chapters in each section have nothing to do with the section in which they were placed and would have fit much better in another section.

Second, there is no coherent scheme that guides the order of the chapters. There is a terrific chapter by Ragins and Pollack, “Recovery and Community Mental Health,” that lays out a basic conceptual model of recovery in the community setting. It should have been in the first few chapters because it could have set the groundwork for many of the other chapters. It is chapter 26. Had it been up front, much of the repetition of other chapters could have been eliminated.

Third, the repetition of material in this book is exhausting. If the Ragins and Pollack chapter had been early in the book, at least five other chapters could have been substantially shortened. The editors, guided by the publisher, could have eliminated material on history in four of the six chapters immediately following the editors’ own chapter on the historical development of public mental health in America.

Quite a number of pairs of chapters could have been collapsed into each other to make room for other topics. The two valuable chapters that include the use of groups for treating people who have serious mental illness, each coauthored by Lefley, could have been one chapter. The chapter on crisis intervention teams (CITs) could easily have been a part of the chapter “Crisis Intervention and Support.” The chapter on suicide risk would have been a natural part of the chapter on risk management. Two chapters seem entirely out of place and add little: one on interdisciplinary work in Verona, Italy, and the final chapter on social systems perspectives.

Fourth, Modern Community Mental Health is not a comprehensive view of modern community mental health. In 621 pages, there is virtually nothing about children or transition-age youth. The elderly population is nowhere to be found, and the reader is provided no information about mental health issues in nursing homes. CIT gets a chapter, but assisted outpatient treatment does not. Managing suicide in the community gets a chapter, but managing violence does not. There’s no coverage of clubhouses. Most surprisingly, there is barely a whisper about the financing of community mental health, and it is hard to understand the practice of community mental health without at least a rudimentary understanding of such influences on the field as cost shifting from the states to the federal government through Medicaid, the exclusion of “institutions for mental disease” from Medicaid matching funds, Medicare Part D, and so forth. Nothing says this book needed to be all inclusive, but the reader should know what’s in the book and what’s not if the book is to guide the reader as the editors said it would (see my first paragraph, above).

Finally, the publishers failed to use a consistent font throughout the chapters, label case studies similarly across chapters, check on spelling of proper names (it’s McLean Hospital, not McClain), caution the editors about overemphasis on just two locations (Ohio and Oregon), and develop a balanced and accurate glossary.

Despite this criticism of the book, I go back to my praise for the chapters. There’s really great stuff here. No one is going to read this book as I did, from beginning to end. So, buy this book or access this book through your library, and read a chapter on a topic that interests you. Sometime later, read another chapter. Use it as a reference. Send trainees to read a chapter. And if you are new in the field, keep the volume for a good long time. By the time you reach the stage in your career where the editors and many of the authors are now, it will be history.