Community Mental Health: Putting Policy Into Practice Globally

Have we created a generation of American psychiatrists who are so oriented to mastering and practicing the technical aspects of individually prescribing expensive medications that we have lost sight of the larger public mission of our profession? As psychiatrists we aim to reduce the pain and suffering caused by mental illness. Far too often, our sights are set on a one-to-one impact rather than on pursuit of leadership and influence in a larger system. Over the past 100 years, we have seen centralized leadership in psychiatric services and treatment move from large asylums to state offices of mental health. More recently we have seen a shift from state offices to managed care entities that states and private insurers hire to manage specialty mental health benefits. This shift has reoriented psychiatrists and mental health professionals as laborers in a complex system rather than as critical members of the design team that creates and manages a system.

That's the background, and here is the point: if you are a psychiatrist or mental health professional who is interested in pursuing professional development that is aligned with assuming leadership roles in health care systems and design, reading Community Mental Health: Putting Policy Into Practice Globally will provide tremendous insight into how other systems and countries with low resources get at the universal goal of reducing the pain and suffering associated with mental illness. The editors of this work are internationally recognized experts in mental health services. The book is a product of a task force of the World Psychiatric Association, reporting on the status of mental health systems priorities and development in several countries. The volume is organized into three sections: an introduction to mental health policies around the world; a detailed description of the priorities, initiatives, and impact of programs; and a final section on lessons learned. This work is easy to read and is a very manageable and well-referenced resource.

Although many of the mental health systems summarized in this book are from developing countries, they have plenty to offer, even to our expensive and highly technical U.S. health care system. A key big idea in contemporary U.S. health policy includes direct emphasis on prevention and population health as a mechanism to improve quality of care, health, and costs. Far too often in the United States, public health is separated from actual treatment. Current U.S. health policy effects health gains largely through a reconfiguration of the relationship between individual health and the health of a fixed population. American patients will increasingly be managed through participation in a primary care population (medical home) or an accountable care organization. Team-based care with specialized paraprofessionals such as community health workers will become commonplace, and developing countries have had greater experience in managing health through public health for decades. Community Mental Health is a great primer on the priorities, initiatives, successes, and failures encountered in other mental health systems.