I sat down eager to read The Mental Health Matrix: A Manual to Improve Services, by Drs. Thornicroft and Tansella, hoping for insights and guidance on methods for reforming public mental health services. I did not find a cookbook-style manual. Rather, this is a book of vision.
In turn, I was exhilarated, challenged, and deeply distressed. The authors demonstrate a coherent, compelling way to think about mental health services and their reform. I realized how hard it is, especially for us Americans, to think this way.
It is important to note that Dr. Thornicroft is British and Dr. Tansella is Italian. Their writing reflects the social-democratic traditions of Western Europe. They can think about a single system of care. The relative simplicity of their systems contributes to the clarity of their concepts and, for an American, to a sense of otherworldliness.
The first of the book's five sections introduces the concept of the matrix model and describes the context for its development. In two exceptional chapters the authors trace the connections between community mental health, public health, and the history of mental health care reform in the West.
In the next two sections, the authors detail the dimensions of the matrix. They are geographical (country-regional, local, and patient levels) and temporal (the input, process, and outcome phases of production). The matrix so formed allows the authors to take a systems-oriented approach to services. They can think broadly and narrowly at the same time, across both time and space.
The fourth section focuses on underlying girders of medical practice and health services and how they are related to the matrix. They include evidence, ethics, and human resources. Each of the chapters is compelling. The chapter on ethics allows for a discussion of social justice in health services; this topic is rarely raised in relation to psychiatric ethics, which tends to focus on the ethics of individual practice. I also especially appreciated the authors' discussion of the central role of teams and teamwork in community mental health. I wish they had said a little more about the specific role of psychiatrists on the teams.
Invited pieces from five contributors from around the world constitute the penultimate section. These authors were asked to apply the matrix in a critical way to their own mental health care systems. Richard Warner, M.D., wrote the chapter on the United States. An Englishman practicing in the U.S., Dr. Warner does an admirable job of capturing both the inadequacies and the dynamism of our nonsystem.
The final section of the book sets a clear and concise agenda for reform in the future. The more people who care about mental health who read this book, the better it will be for all of us.
