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Book Review   |    
Designing Mental Health Services and Systems for Children and Adolescents: A Shrewd Investment
Gordon Harper, M.D.
Psychiatric Services 1999; doi:
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edited by J. Gerald Young, M.D., and Pierre Ferrari, M.D.; Philadelphia, Brunner/Mazel, 1998, 476 pages, $59.95

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The development of mental health services for children and adolescents around the world has lagged behind the development of other health services, which is surprising given the long-term consequences of providing or omitting such services for the next generation of adults.

This book summarizes efforts to develop the knowledge base and practice experience necessary for such systems. By so doing, it aims to foster the further growth of such services around the world. The book evolved from a 1996 conference in Venice organized by the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP). Conference organizers were responding to the opportunity, with the opening up of contacts with former Soviet countries, to develop a wider international child psychiatric community. That opportunity coincided with the challenge presented by the simultaneous retrenchment of services in the West under cost-containment pressures including managed care. Of the 43 authors, 13 come from the United States (including six from the Yale Child Study Center), 19 from Western Europe, five from Central Europe and Russia, two from Latin America, two from Israel, and two from Asia.

The book begins with a developmental, clinical, and epidemiological overview of psychopathology in children. A second section reviews the "costs of developmental psychopathology" in the organization and financing of services, making the argument of the book's subtitle that mental health services for children and adolescents, with their longer-term benefits in reducing socially costly adult dysfunction, are a "shrewd investment."

Subsequent sections review developments in the United States and Western Europe, in the emerging societies of Central Europe and Russia, and in India, Hong Kong, Brazil, and Israel. The book concludes with efforts to reconcile economic strategies and the needs of children, including recommendations that were made by the IACAPAP after the Venice conference and summarized in the "Declaration of Venice: Principles for Organizing Mental Health Systems for Children and Adolescents."

The book makes several important contributions. It puts child mental health into the framework of worldwide public health. It points out that such a perspective is necessarily multigenerational, summarizing the data on the effects of intervention (or its absence) on longer-term adaptation and social costs. It makes it clear that child mental health is necessarily a developmental specialty, acknowledging the uses and the limitations of categorical diagnoses for clinical services and service planning alike. It summarizes and argues for more support for the research agenda that will extend knowledge of developmental psychopathology and adaptation, of effective services, and of service organization.

This multiauthor book is well written, speaking to the reader both on the personal level—contrasting the high value individual adults place on caring for their children with the weakness of public protection and services for children—and on the level of epidemiology and systems planning. Clinicians and planners alike will appreciate the summaries from an international perspective of developmental psychopathology and of services research, as well as the overview of child mental health services around the world.

The book is recommended for clinicians, health planners, and the concerned general reader.

The accomplishment of the editors and authors in assembling such a book leaves the reader freshly aware of the great divide that impacts children's lives: the gulf between the intense, long-term, generative interest individual parents take in their children's development and the short-term perspectives that drive much public policy. The mental health of the next generation weighs light on public balance scales, particularly in conditions of political or social instability or where the political process lacks an inclusive view of a country's children and a protective and generative view of adults' role toward them.

Dr. Harper is associate professor of psychiatry at Harvard Medical School in Boston and medical director of child and adolescent services for the Massachusetts Department of Mental Health.

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