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Book Reviews   |    
Community Mental Health Teams: A Guide to Current Practices
Reviewed by Curtis N. Adams, Jr., M.D.
Psychiatric Services 2005; doi: 10.1176/appi.ps.56.4.497
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by Tom Burns; New York, Oxford University Press, 2004, 224 pages, $47.50 softcover

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Community Mental Health Teams: A Guide to Current Practices offers an overview of the current provision of mental health services in Britain. Although teams from other parts of the world are mentioned, the British system dominates the book. Tom Burns, the sole author, states his reasons for this approach in the preface: it enables him to scrutinize the difference between what is published about a given service (such as assertive outreach) and what actually happens on such teams. The book is intended as a guide, not a manual, so although some detail is included, that is not the author's emphasis. Rather, Burns offers his observations about how teams are structured and what seems to work well or poorly on given teams. Also, his book is more experiential and less an evidence-based guide.

Burns, a social psychiatrist, first gives a brief history of deinstitutionalization in Britain as an introduction to the development of modern community mental health teams. Next, he describes various teams from the "generic" community mental health team to specialized teams such as the early intervention teams, which target persons with first-break or recent-onset schizophrenia. The book has the feel of a Tom Burns lecture, and there were times when I could hear his presentation but wished I could also see the slides or ask questions to clarify some of his points.

A reader who is not accustomed to British English may be puzzled by some of the idiomatic expressions in the book. Visits to the Internet helped clarify some terms, but not all. A glossary would have helped. A bigger challenge was grappling with terms that are specific to the British mental health system. Acronyms such as "SHOs" and "SpR" were more difficult to interpret, because they were never defined in the text. In some places the author uses acronyms before he defines them. For example, he mentions "EPPIC" on page 112, but it is not until page 118 that we are told that this is shorthand for "early psychosis prevention and intervention center." He also refers to "DGH" without first defining it as "district general hospital." This type of flaw appears often enough to be distracting and should have been edited out.

Another concern was the occasional obscure or inaccurate reference. On page 181, the author mentions a "Gramsian Marxist." Is he referring to Antonio Gramsci? Internet searches did not clarify this. On page 53 he writes, "In the U.S…. individuals established by psychiatrists to suffer from a severe and enduring mental illness receive their mental health services free." This statement is an oversimplification.

Despite those weaknesses, I enjoyed reading the book, because it offered a view of a system that was unknown to me, presented by a capable and experienced guide. Leaders of teams and systems of care will find the overview that this book provides very useful. Community Mental Health Teams is most valuable because team leaders and practitioners can easily use the many practical pearls of wisdom at little cost.

Dr. Adams is affiliated with the division of community psychiatry of the University of Maryland in Baltimore.

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