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Book Forum: Mental Health Services   |    
Mental Health Services: A Public Health Perspective, 2nd ed.
Am J Psychiatry 2005;162:830-830. doi:10.1176/appi.ajp.162.4.830
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Pittsburgh, Pa.

By Bruce Lubotsky Levin, John Petrila, and Kevin D. Hennessy. New York, Oxford University Press, 2004, 474 pp., $65.00.

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As someone whose interests span clinical, research, and policy issues in behavioral health services, I am often called upon to meet with students and trainees who are interested in policy and administration. I also codirect a seminar series on social and community psychiatry for psychiatric residents and frequently present lectures to medical or public health students on the "mental health system" and related policy issues. As such, I was looking forward to identifying a single text that I could share with interested students and use as a backbone for the seminar. Mental Health Services: A Public Health Perspective has a number of positive attributes, but, overall, it does not have the coverage and focus to meet that need.

The text has 20 chapters organized into four parts: Service Delivery Issues, Selected Populations at Risk (children and adolescents, adults, older adults, substance abuse), Special Issues, and Managing Mental Health Systems. The book’s greatest strengths are quality of the contributors (all are major leaders in each of the domains selected) and the broad range of disciplines represented. The greatest weaknesses are the lack of a cohesive vision and insufficient linkages among the chapters. As a result, a student would not really get the big picture. To try to remedy this often encountered problem in multiauthored texts, the editors had most authors include a section at the end of each chapter titled Implications for Mental Health Services. However, no consistent framework is discernible for how the authors determined the implications, and the sections often seem tacked on.

Another problem that limits the applicability to non-mental-health disciplines is that there is very little on the nature of treatment for behavioral conditions and their effectiveness (especially for those who are not seriously mentally ill). Also, some clinical vignettes might help nonclinicians get a more concrete sense of how practices and policies affect individuals. The epidemiology chapters are all excellent reviews of the literature, but they provide very little connection to services and policy issues per se. As a text for nonepidemiologists, the book might have included a section on how these surveys are typically conducted, warts and all. There is a chapter titled "Co-Occurring Disorders," but most other chapters ignore this phenomenon. For example, the chapter on criminal justice says almost nothing about substance abuse.

There are some outstanding chapters that I would certainly offer to trainees with specific interest: "Mental Health Disability Law," "Policy and Services Delivery," "Child Mental Health Policy," "Mental Health Policy and Aging," and the chapter on evaluation are all comprehensive and superb.

Finally, despite the subtitle, A Public Health Perspective, that perspective does not appear to be well represented in the text. For example, epidemiologic data strongly demonstrate that the largest proportion of mental health care is provided in the primary care sector, yet there is no chapter focused on that issue.




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