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50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar 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ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and 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Mental Health Policy in BritainReview - Mental Health Policy in Britain
A Critical Introduction
by Anne Rogers and David Pilgrim
Macmillan Press, 1996
Review by Rachel V. Cooper
Dec 15th 1999 (Volume 3, Issue 50)

During the 1980s "community care" began to be implemented throughout Britain. In theory the closing mental hospitals were to be replaced by group homes, day centres and other community-based facilities for the mentally ill. What happened in reality is less clear cut. While clearly some mental patients benefited from the new community based care, there has been much suspicion that others ended up worse off than they were before - homeless, living in squalor or in prison. In the wake of the introduction of community care many questions remain to be addressed: What happened to the patients released from the old asylums? How can those mentally ill people who are potentially dangerous be controlled within the community? Should the remaining mental hospitals also be closed? In short, how should society deal with the mentally ill?

Mental Health Policy In Britain aims to provide the reader with the background required to participate in these debates. The first half of the book outlines the historical development of mental health policy in Britain, the second aims to provide an up-to-date analysis of current policy. The prose is too tough going for the book to be accessible to a general audience and the book is intended as a textbook for undergraduate courses.

Although published in 1996, the book relies almost exclusively on sources that were published prior to 1993. As a result the "current policy" section of the book falls uncomfortably in the gap between current affairs and history. Mental health policy is changing at such a rate that the section is too out-of-date to provide a satisfactory overview of current policy. The section is also of limited value as a historical study of mental health policy in the Thatcher years as 1993 was too close to the introduction of community care for sufficient data regarding its consequences to have been available for analysis.

The historical section of the book is also unsatisfactory. Rogers and Pilgrim purport to provide a balanced introduction to the debates regarding mental health policy and yet a strong anti-psychiatric bias is evident throughout. At several points claims concerning the evils of psychiatry verge on the libellous. For example, Rogers and Pilgrim suggest that the high death rates in 1930s mental hospitals were significantly boosted by deaths resulting from lobotomies and ECT treatment. In fact very few patients died as a result of these treatments. ECT treatment results in death in between 3 and 9 out of 100,000 treatments, a figure comparable to the death rate associated with dental treatment (Royal College of Psychiatrists 1977). Lobotomies are more dangerous, but still resulted in only about 33 deaths a year (calculated on the basis of data from Tooth and Newton 1961). Of course one might argue that these death rates are still too high to be acceptable, but the claim that these treatments killed thousands of people is clearly false.

To sum up, Mental Health Policy in Britain is too out-of-date to provide an overview of current policy, and too biased to make a good introduction to the historical background of the contemporary debate.

References

Tooth and Newton (1961) Leucotomy in England and Wales 1942-1954: reports on Public Health and Medical subjects no 104. (London: HMSO)

The Royal College of Psychiatrists (1977) Memorandum on the use of electroconvulsive therapy. British Journal of Psychiatry. 131 pp261-272

Rachel Cooper is a lecturer in the Department of Philosophy at the University of Bristol, England. She has research interests in the philosophy of science, especially psychiatry, and in 20th century history of psychiatry.

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