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Book Reviews   |    
The Casebook of a Residential Care Psychiatrist: Psychopharmacosocioeconomics and the Treatment of Schizophrenia in Residential Care Facilities
Reviewed by Timothy A. Kelly; Deborah E. Gorton
Psychiatric Services 2006; doi:
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by Martin Fleishman, M.D., Ph.D.; Binghamton, New York, Haworth Press, 2005, 446 pages, $49.95 softcover

Dr. Kelly and Ms. Gorton are affiliated with the Fuller Graduate School of Psychology, Pasadena, California.

Dr. Martin Fleishman has more than 50 years of experience as a psychologist and psychiatrist and specializes in the treatment of schizophrenia in residential care settings—group homes that include medication management. He is an expert in the multiple dimensions of treatment in such settings, including psychopharmacology, psychosocial treatment, and legal and economic considerations. The Casebook of a Residential Care Psychiatrist is offered not only as a manual on how to provide quality residential care but also as a critique of the current system of care. The book is also a call for new mental health policies to promote more effective and efficient residential services for people with serious mental illnesses.

In the book Fleishman walks through the people, places, and problems inherent in residential care. Drawing on his vast experience and the literature, he provides a thorough overview of the tasks and challenges facing providers, including, for example, a chapter subsection titled "A Typical Day in the Life of a Residential Care Facility Psychiatrist." His detailed presentations, usually flavored with a personal anecdote, thoroughly cover every aspect of care. Fleishman provides explicit guidelines for how to interview and assess patients in a time-sensitive manner, how to reduce the often overwhelming task of paperwork, and how visits should be conducted with regard to frequency, duration, and space. He also provides information about the ideal provider team and how to maximize each member's contribution, the critical role of psychopharmacology in residential care, and the impact of state and federal regulations with regard to various mental health services available in residential settings.

By using a welcoming writing style, Fleishman invites the reader to accompany him on a personal journey through the challenges and intricacies of residential care psychiatry. Although the book is a straightforward read overall, Fleishman sometimes has a tendency to wander off course in an attempt at humorous narrative that can seem unnecessary and even a bit distasteful. However, the author does acknowledge his propensity for digression and states, "If there is a bon mot lurking in that part of my brain in which comedic material accumulates, then it must be expressed or I get very nervous even if it leads to digressive ramblings—as is exemplified by this paragraph and to an extent, throughout this book." He also lets the reader know early on that the book is "partly autobiographical—nostalgically so … and unapologetically so." Thus an idiosyncratic aspect to this book works well at times yet at other times can get in the way of the point being made. However, these whimsical forays do not prevent the book from detailing how to provide quality residential care in a clear and comprehensive manner.

Overall this volume is an applied clinical guidebook and is useful for any mental health provider interested in quality residential care for people with serious mental illness. Replete with case vignettes that shed a sensitive yet candid light on the complexity of caring for people with chronic and severe schizophrenia, Fleishman's book offers the reader a learning experience marked by practical wisdom and personal insight. The book is thus a refreshing departure from the characteristically dry and technical writing of many educational texts and is a good read for those so inclined.

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