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Book Reviews   |    
Mental Health Professionals in Medical Settings: A Primer
Reviewed by David F. Gitlin, M.D.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.7.1047
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by JoEllen Patterson, Ph.D., C. J. Peek, Ph.D., Richard L. Heinrich, M.D., Richard J. Bischoff, Ph.D., and Joseph Scherger, M.D., M.P.H.; New York, W. W. Norton & Company, Inc., 2002, 232 pages, $40

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The integration of mental health services into primary care settings has been an area of growing interest and activity over the past decade. The authors of Mental Health Professionals in Medical Settings: A Primer have put together a thoughtful treatise on how to practically establish mental health care in medical settings. In this work they have systematically applied their experience and research from a wide variety of mental health and medical disciplines.

The text takes a look at the full range of issues. The authors begin by reviewing the literature on the scope of mental disorders seen in primary care, the inadequacies of treatment in these settings, and how the integration of mental health providers into medical settings may be one element of the solution. They then methodically discuss the differences between traditional medical and mental health settings and establish a functional schema for what mental health professionals need to consider before attempting to establish a mental health service in these venues. The text concludes with some discussion of approaches to specific clinical situations seen in the medical setting. It achieves each of these goals with some success. In particular, the chapters on establishing a mental health presence in the medical setting offer a comprehensive understanding of the complexities associated with this endeavor.

The authors state in their introduction that their target readership is all mental health professionals. This broad ambition, unfortunately, results in the major shortcoming of the text. The authors use a good proportion of the book to explain basic concepts of medical care and primary clinic operations, presumably for the benefit of nonmedical mental health providers. In appealing to the least medically trained providers, the authors have put together large parts of text that are of limited value, especially to psychiatrists. The text has a tendency to discuss psychiatry and clinical social work in the same breath. Psychiatry and psychiatrists are, at times, trivialized. For example, at one point the authors state that "psychiatry has largely abandoned psychoanalysis and much of psychotherapy." There is an apparent desire to reduce the different expertise of the various mental health disciplines to the least common denominator. The authors go so far as to distort previous studies to support concepts such as "research evidence…suggests that professional affiliation or type of license results in no significant difference in patient treatment outcomes." It is interesting that although the text's premise is integration into medical settings, the book repeatedly devalues medical treatments in psychiatry.

This bias notwithstanding, the authors have added a valuable text to the growing literature on the integration of mental health care into medical settings. For the mental health provider who wants to begin developing these relationships, this text will be a worthwhile primer.

Dr. Gitlin is director of medical psychiatry at Brigham and Women's/Faulkner Hospital in Boston.




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