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Book Reviews   |    
Where There Is No Psychiatrist: A Mental Health Care Manual
Reviewed by Michael A. Bell, M.D.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.2.200
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by Vikram Patel; London, England, Gaskell, 2003, 266 pages, $14 softcover

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In Where There Is No Psychiatrist: A Mental Health Care Manual, the importance of meeting the mental health care needs of the emerging global village is emphasized. Unfortunately, even in these modern times, a significant majority of people worldwide reside in regions in which there is virtually no access to mental health care professionals.

This manual is written primarily for general health workers and the families they serve in the field. The author attempts to translate the often-complex world of psychiatric concepts and jargon for readers who perhaps have had limited exposure to the identification and treatment of mental pathology.

The book covers a vast array of topics in psychiatry. Each topic is discussed in light of the latest scientific research, yet the discussion manages to remain culturally sensitive. Barriers to providing adequate treatment for mental illnesses go beyond simple geography. Where There Is No Psychiatrist seeks to replace the barriers of stigma, myth, and tradition with practical and efficient methods of treating persons with mental illness. Clinicians in developing countries will find this manual particularly helpful for educating their staff and the families they work with. But even Western-trained psychiatrists may benefit from various discussions throughout the text, especially those involving cultural awareness.

This manual follows evidence-based psychiatric interventions and manages not to get too detailed in terms of the research behind such treatments. It is noteworthy that the author, Vikram Patel, omitted such detail, considering how this might distract readers from the main theme of making psychiatry more accessible. Great teachers have a way of reducing the dusty volumes that sit on the shelves of our libraries into meaningful experiences that can be used to help others. Patel, an honorary senior lecturer at the Institute of Psychiatry in London, is such a teacher. Through this book a busy family doctor in the "bush" of central Africa can be empowered to treat any mental disorder and help the patient and his or her family to understand the mental illness. Patients who were once considered bizarre by their community—with various and often-negative consequences—can now be seen as having a mental disorder.

This inexpensive, easy-to-read text is a valuable resource, providing extensive coverage of topics and discussion of diverse cultures and evidence-based medicine. It represents an excellent handbook for disbursement in parts of the world in which there is a shortage of mental health care services. The author achieved his stated goal of creating a "practical, clinically oriented manual."

Dr. Bell is chief resident in ambulatory psychiatry and research in the department of psychiatry at the University of Massachusetts Medical Center in Worcester.

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