Community Mental Health: Challenges for the 21st Century

The treatment of serious mental illness has traveled a difficult and unpredictable road since the passage of the Community Mental Health Act of 1963. Providers and funding agencies have struggled to define the most effective mental health care delivery system, while consumers and families have hoped to find firm footing in an ever-changing sea of shifting regulations and resources. More often than not, the climate over the past 50 years has been bleak. Predicting what is to come next is a risky endeavor. Jessica and Samuel Rosenberg have skillfully and successfully embarked on such a mission with their book, Community Mental Health . The editors, both seasoned mental health care providers, educators, and directors of programs with expertise in cultural diversity, family, and serious mental illness, have compiled a series of articles that provide the reader with a solid understanding of community mental health, including a historical perspective, current practice, and the challenges that lie ahead for programming and funding.

Organized into five major sections, the book begins with what is perhaps the most powerful collection of writings on the recovery and consumer movement. Each article provides a comprehensive historical perspective leading up to the current construct of consumer-defined services shaped by hope and self-determination.

The second section, "Best Practices in Community Mental Health," is, disappointingly, the least developed. Although opening the section with an outstanding presentation of "Evidence-Based Treatment for Adults With Co-occurring Mental and Substance Use Disorders," which includes a comprehensive account of the integrated-dual-diagnosis treatment model, the editors have conspicuously omitted any discussion of the well-established best practices of supported employment and family integration strategies. These serious omissions result in a shortfall of attempting to present a "comprehensive text."

In the third and fourth sections, the editors present a collection of outstanding articles covering the issue of mental health services to the underserved. The third section includes a thorough discussion of the phenomenon of oppression and the experiences of the African-American, Chinese-American, Hispanic, and lesbian, gay, bisexual, and transgender populations. The fourth section contains three very thorough articles on working with people with mental illness who are homeless and begins with an excellent review of stigma.

The final section, "Community Mental Health: Organizational and Policy Issues," reviews the impact of managed care, organizational networks, and shifting funding sources for public mental health programs on the community mental health delivery system. The book concludes with "Mental Health Leadership in a Turbulent World." This final discussion leaves the reader surprisingly hopeful.

Overall, Jessica and Samuel Rosenberg have compiled a series of well-written, educational articles that provide a solid understanding of the history and current approach to community mental health. Although mostly written for students of social work, psychology, psychiatry, and related disciplines, the sections on underserved populations are excellent resources for seasoned clinicians and program directors. The entire read was a stark reminder of where community mental health has come from and a validation of things that are developing in a more positive direction.