Effective advocacy for resources and effective administration of mental health services are important capacities. They require at least as much wisdom and cooperation as the humane and well-informed practice of psychiatry. The appearance of this volume is welcome in that it emphasizes the interdependence of these areas of work and addresses many broad issues affecting and affected by the practice of psychiatry.
The book is a collaboration between American Psychiatric Press and the World Psychiatric Association and is published in conjunction with the tenth World Congress of Psychiatry. The publishing history suggests much energy and distillation of thought. The editors' stated aim is to move from the relatively narrow confines of psychiatry, as covered in the first volume of the series, to address broader issues. They are well aware of the dangers of loss of focus.
For me, much of the interest and stimulation of the book comes from reading the justifications from the distinguished group of editors and section editors for their choices and themes. For instance, Dr. Mak writes in the foreword that "the exploding cost of health care has led governments to focus on cost containment and cost reduction without effectively dealing with the problems engendered by misallocation, waste, and inequitable distribution of resources."
The section on the economic aspects of mental health then invites us to go beyond bemoaning the impoverished state of most mental health services to embrace the critical issue of economic analyses of the problem of mental illness. Section editors Harold M. Visotsky and Norman Sartorius point out that "indicators of cost of illness and cost of treatment, as well as indicators of direct and indirect gain in terms of money (and quality of life), are poorly developed, rarely used, and differently interpreted." Clinicians unsure about how this thinking fits with responsibility to each patient are likely to find the section a useful discussion, although they will need to look to some of the citations to find more on the basics of health economics.
The section on violence is beautifully crafted to discuss the epidemiology of extreme violence, posttraumatic stress disorder among victims, and the treatment of violent patients. While supporters of the gun lobby will find no joy, the contributions remain relevant to psychiatry.
The sections on traumatic stress and on childhood and adolescence each constitute one-third of the volume. Although they lack the coherence of the previous sections, they tackle major areas such as torture and refugee trauma, stress disorder and medicolegal issues, child abuse and neglect, and adolescent suicide. The emphasis is on the continuing need to examine practice and definitions as experience is shared across cultures and across emerging and difficult areas of practice.
I recommend this volume to those working in mental health services. It is not a primer, but rather a stimulus to think more broadly.
