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Book Review   |    
Comprehensive Emergency Mental Health Care
Donna M. Moores, M.D.
Psychiatric Services 1998; doi:
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by Joseph J. Zealberg, M.D., and Alberto B. Santos, M.D., with Jackie A. Puckett, L.M.S.W.; New York City, W. W. Norton & Company, 1996, 290 pages, $37

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This very readable, practical book presents an excellent outline of emergency behavioral health services. The authors describe their text as presenting a model of effective mobile emergency treatment services, providing a core of information legitimizing high-quality mental health crisis services in nontraditional settings, and serving as a training manual. The book fairly admirably reaches these goals.

The authors are practicing psychiatrists and teachers, and their expertise in both of these areas is evident in their writing. Their level of comfort with this subject and their low-key approach is obvious even in the section titles, such as Nuts and Bolts of Program Operation, and Crash Course in Medical Psychiatry for the Nonphysician.

Comprehensive Emergency Mental Health Care is written for a multidisciplinary audience, assuming a team approach to treatment. It moves from organizational theory, with attention to fiscal and political realities, to operational detail. Attention is given to the position of emergency and mobile services on the full continuum of mental health care. The emergency treatment team, as the authors envision it and have organized it, moves out of the confines of a particular building or institution—away from the traditional triage service to one that can provide definitive treatment in an impressive, modern-day version of the house call.

The unifying focus is the patient who typically presents in a multifaceted crisis involving psychiatric symptoms, social stressors and support failures, medical-status questions, and safety issues. Thoughtful, sound approaches to care as well as specific protocols, forms, and other tools are included. Rich clinical detail and useful case examples are interspersed in a helpful, enlivening manner. The authors also attend to the needs of the practicing clinicians, offering strategies to combat burnout, and enhance clinical effectiveness through education, involvement in the process, and intense support

Emergency psychiatry is a very hands-on practice that requires a high level of organization and integration. Patients must be thoroughly yet efficiently evaluated. Individuals who are out of control or out of touch need humane, respectful attention. Important linkages must be made with the family, community supports, systems of mental health care, and medical services. Each emergency intervention is a unique opportunity to have a positive impact on a vulnerable person, an overwhelmed family. The accompanying risks are high.

It is into such a high-pressure environment that this book brings order and optimism where there so often can be chaos. Front-line staff need training and support. Administrative organization must be logical and accessible. The services should have a sense of overall mission as well as day-to-day goals to focus the work. Drs. Zealberg and Santos have faced these challenges and given us a guidebook that can be useful to those in training, in practice, and in management.

Dr. Moores is chief of clinical programs in psychiatry at the Boston Medical Center and vice-chair for clinical programs in the department of psychiatry at Boston University School of Medicine.

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