Oxford Textbook of Community Mental Health

Trying to create a textbook of community psychiatry with international contributors but without a cross-cultural focus is a herculean task. Thornicroft and Szmukler (United Kingdom) and Mueser and Drake (United States) made a valiant effort, with mixed results. The Oxford Textbook of Community Mental Health is generally a patchwork quilt of English chapters and American chapters, with a thread or two from continental Europe, Australia, and New Zealand. And there is little that ties these chapters together.

The last chapter, “Looking to the Future,” written by the four editors, is excellent and probably should have been the first chapter. Opening with this chapter would have provided the textbook's contributors a focal point and the reader some unifying themes.

Two warnings: First, don't expect this textbook to be a how-to for community psychiatry—it's not. It's more an explanation of what community psychiatry is about. Second, don't try to read this book cover to cover—the cultural shifts are jarring.

One suggestion: Read a chapter on a topic of interest to you. Despite the disjointedness, there is much to be gleaned from these pages.

Community psychiatry is covered quite broadly, leaving significant gaps within sections and chapters. The section on policies and funding has a sweeping international perspective and provides little insight into the situation in the United States. The section on ethical and legal aspects is excellent but includes no discussion of coercion or compulsion through involuntary outpatient treatment—a controversial subject in all the countries represented by the authors in this textbook. Section 9, on methods for ensuring effective care, covers an issue for virtually every community psychiatrist worldwide, but this section disappoints, doing little more than discuss guidelines. It discusses some impediments in low- and middle-income countries, but what about high-income countries? Problems abound in the United States, United Kingdom, and elsewhere.

As is always the case with books that have multiple contributors, the book is uneven. The section on stigma and discrimination seems to address the lay public, a readership different from that addressed by the rest of the book. It was baffling that the editors reprinted an article from Lancet, listing 29 authors, rather than having one or two of those authors adapt the article for a textbook chapter.

Some chapters, such as the one on psychopharmacology, cover material with no apparent specificity to community psychiatry. Other chapters hit their mark, such as the well-executed chapters on crisis and emergency services, early intervention, case management and assertive community treatment, day and partial-day treatment programs, and residential care. Chapters that provide up-to-date discussions on topics of particularly contemporary interest—employment, medical comorbidity, and illness self-management—are a fine starting point for anyone wanting to garner an understanding of these topics. The chapter on inpatient psychiatry is very strong, although the interface between hospital and community psychiatry receives too little attention and a discussion of integrated treatment plans would have been welcome.

I highly recommend to American readers the chapters on issues of great importance in global psychiatry, about which too many in the United States and Canada know too little: global burden of mental disorders, mental health challenges of immigration, and ethnicity and cultural diversity.

What's missing? Although the book is roughly 500 standard-size 8½×11-inch (A4) pages, the editors still had to pick and choose what to cover, and chapters on treatment planning and on disability would have been useful additions.

What's the bottom line? I salute the four editors for trying to bridge the gap of the Atlantic to provide a textbook for cross-cultural consumption. Although their success is somewhat mixed, they have provided a reference book from which any reader can learn about how community mental health is done in one's own country and how it's done someplace else. We all would benefit from knowing more about both.