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Book Forum: Cross-Cultural Psychiatry   |    
Mental Health Global Policies and Human Rights
Am J Psychiatry 2005;162:1238-a-1239.
View Author and Article Information
San Diego, Calif.

Edited by Peter Morrall, Ph.D., M.Sc., B.A.(Hons), P.G.C.E., R.N., and Mike Hazelton, Ph.D., M.A., B.A., F.A.N.Z.C.M.H.N., R.N. London, Whurr Publishers (Abingdon, Oxfordshire, U.K., Taylor & Francis Group, distributor), 2004, 196 pp., $38.95 (paper).

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This well-written volume, resulting from the efforts of a distinguished group of authors, has a great deal of information about the history of mental health initiatives, the progress made in recent decades, the current conditions, and the possible future of mental health policies in 10 countries: the United Kingdom, United States, Australia, Italy, Egypt, India, Brazil, Russia, and Mozambique. Only one chapter is focused on a single theme, and the reader can immediately tell the opinion of the authors: "Mental Health Policy in China: The Persecution of Falun Gong." This is also the only chapter with a clarification: "The views expressed in this article do not represent any group or association." This chapter is not necessarily relevant to the rest of the book.

The editors state in the introduction,

Throughout both the developed and the developing regions of the world the treatment and care of the mentally disordered, the prevention of mental health problems, and the improvement of the mental health status of all citizens, have entered the political domain at national and international levels.

This is good, but by itself doesn’t seem to solve any problems, or at least not now. Efforts for better mental health seem to have been on a roller coaster. Dr. Morrall, one of the editors, is also the author of the chapter on the United Kingdom. In describing the current situation, he uses such telling words as "overload," "opprobrium," "incoherence," and "terror." One fears that the sane policies "crucial to create calm from chaos" are not yet in the horizon.

Professor Smoyak, the psychiatric nurse who wrote the chapter on the United States, also sees many problems but is more optimistic. She sees a future in which knowledgeable consumers ally themselves with groups of professionals to advance best clinical practices.

In the midst of change, the United Kingdom and the United States seem stable when one reads about the extraordinary changes in mental health policies in Australia, Italy, Russia, and Brazil. Australia has had changes that have advanced consumerism but remain uncertain and related to fluctuations in national policies. All in all, "it is not clear that the life circumstances of mentally ill persons are changing for the better." The radical ideas of the late 1960s and early 1970s in Italy led to changes considered extreme and antipsychiatry by many; they included the effective destruction of hospital psychiatry and led to a reaction, a reform movement that started in the late 1970s and is still evolving. Russia has undergone profound political changes that may have had a minimal effect on the individual patient. "In the contemporary situation mental health policy is again being defined by the priorities of the state, with little opportunity for society or the individual to exert influence." Brazil is no doubt much more democratic, and is now evolving the way the United Kingdom and the United States did in decades past. One would hope that this evolution ends in better results than its predecessors. Mozambique is admittedly far behind, lacks financial and professional assets, and has a very long way to go. India and Egypt have long, rich, and distinguished histories of concern for the mentally ill. Their current progressive policies may lead to the problems other countries face.

One may conclude that the battle in favor of the mentally ill still rages in many countries, and the warriors who favor the well-being of the mentally ill may not be able to forecast a real victory as yet.




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