Mental Health Services: A Public Health Perspective

This edited volume represents the first attempt to provide an integrated text of the critical elements and issues of mental health policy, management, and service delivery within a public health framework. This approach requires the integration of knowledge derived from mental health epidemiology, treatment, and service system research.

The editors are well suited to this challenge. Both are from Florida Mental Health Institute, a multidisciplinary research and training institute whose efforts are focused on the public mental health system. Dr. Levin is trained in public health and is noted for his writings on mental health administration and policy. Mr. Petrila is trained as a lawyer and known for his critical assessments of the impact of legislation and regulation on service delivery.

The first, and strongest, of the volume's four sections covers core mental health service delivery issues including organization, legislation and regulations, economics, financial management, quality improvement, consumer and family advocacy, evaluation, and multicultural perspectives. All the contributors to this section are nationally recognized experts on their respective topics.

The chapters in this section generally are good comprehensive overviews of the substantive issues covered, such as the chapters on mental health services by Elpers and Levin, on economics of mental health by Frank and McGuire, and on the impact of consumer and family advocacy on service delivery by Lefley. However, for readers well versed in mental health service delivery issues, they offer little new information. The chapters on evaluation written by Orwin and Goldman and on the impact of disability law on mental health policy and services by Petrila and Levin are strikingly innovative and do provide new insights.

The following three sections are devoted to three specialized populations—children and adolescents, the elderly, and adults with substance abuse problems—with each containing three chapters on the relevant epidemiological, treatment, and policy issues. These sections are uneven in quality and comprehensiveness. For example, the chapter on epidemiology of psychiatric disorders among the elderly is too detailed, and the reader becomes impatient. On the other hand, the treatment chapters in these three sections provide rather limited coverage; in addition, they have an extremely clinical orientation, not well balanced with a service perspective. The selection of these three populations results in the omission of relevant treatment, service, and policy issues related to adults with severe mental illness, such as those who are homeless, those who are in jails and prisons, and those who need psychiatric rehabilitation.

This book suffers from the typical problems of edited volumes, variable quality and redundancy of information. Given the book's significant gaps, it falls somewhat short of being a comprehensive introduction to mental health services from a public health perspective. However, many practice disciplines, such as social work, nursing, and psychiatry, need a single source that offers an overview of mental health services and related policy issues. With the use of some supplemental material, this book can serve as such an introduction, for there is no text that currently competes with it.

Dr. Solomon is professor in the School of Social Work at the University of Pennsylvania in Philadelphia.