Mental Health
Resources

 email page    print page

All Topic Reviews
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 DisorderBipolar DisorderBipolar Disorder DemystifiedBlack-eyed SuzieBlaming the BrainBleeding to Ease the PainBluebirdBlueprints Clinical Cases in PsychiatryBody Image, Eating Disorders, and ObesityBorderline Personality DisorderBrain Circuitry and Signaling in PsychiatryBrave New BrainBreakdown of WillBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerCalm EnergyCassandra's DaughterCaught in the NetChild and Adolescent Treatment for Social Work PracticeChildren Changed by TraumaChronic Fatigue Syndrome (The Facts)Clinical Handbook of Psychological DisordersClinical Manual of Women's Mental HealthCognitive Theories of Mental IllnessCommonsense RebellionCommunity and In-Home Behavioral Health TreatmentComprehending SuicideConcise Guide to Child and Adolescent PsychiatryConquering Post-Traumatic Stress DisorderConscience and ConvenienceConsciousnessConsole and ClassifyContesting PsychiatryCoping With TraumaCopshockCrazy for YouCrazy in AmericaCrazy Like UsCreating HysteriaCritical PsychiatryCruel CompassionCultural Assessment in Clinical PsychiatryCulture and Mental HealthCulture and Psychiatric DiagnosisCultures of NeurastheniaDaddy's GirlsDante's CureDarwinian PsychiatryDaughter of the Queen of ShebaDaughters of MadnessDeinstitutionalization And People With Intellectual DisabilitiesDelivered from DistractionDepression In Later LifeDepression SourcebookDepression-Free for LifeDescriptions and PrescriptionsDestructive Trends in Mental HealthDevil in the DetailsDiagnosis: SchizophreniaDiagnostic and Statistical Manual of Mental Disorders DSM-IV-TRDirty Filthy Love DVDDisorders Of DesireDisrupted LivesDissociative ChildrenDivided MindsDr. Andrew Weil's Guide to Optimum HealthDr. Weisinger's Anger Work-Out BookDSM-IV SourcebookDSM-IV-TR CasebookDSM-IV-TR in ActionDSM-IV-TR Mental DisordersE-TherapyEccentricsElectroshockEmergencies in Mental Health PracticeEmergency PsychiatryEmotional and Behavioral Problems of Young 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 SadMadhouseMadnessMadness at HomeMadness in Buenos AiresManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityMary BarnesMasters of the MindMeasuring PsychopathologyMedia MadnessMedicine As MinistryMelancholy And the Care of the SoulMemory, Brain, and BeliefMental HealthMental Health At The CrossroadsMental Health Issues in Lesbian, Gay, Bisexual, and Transgender Communities Mental Health MattersMental Health Policy in BritainMental Health Policy in BritainMental Health Professionals, Minorities and the PoorMental IllnessMental Illness and Your TownMental Illness, Medicine and LawMental SlaveryMindfulness in Plain EnglishModels of MadnessMothers Who Kill Their ChildrenMozart's Brain and the Fighter PilotMultifamily Groups in the Treatment of Severe Psychiatric DisordersMuses, Madmen, and ProphetsMyths of ChildhoodNapkin NotesNeural MisfireNew Hope For People With Bipolar DisorderNight Falls FastNo Enemies WithinNolaNormalNot CrazyNovember of the SoulOf Two MindsOn Being Normal and Other DisordersOn Our Own, TogetherOn The Stigma Of Mental IllnessOrigins of Human NatureOut of Its MindOut of the ShadowsOvercoming Compulsive HoardingPathologies of BeliefPathways through PainPersonal Recovery and Mental IllnessPersonality Disorder: Temperament or Trauma?Pillar of SaltPoints of ViewPoppy ShakespearePosttraumatic Stress DisorderPsychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric Genetics and GenomicsPsychiatric Illness in WomenPsychiatrists and Traditional HealersPsychiatryPsychiatry and ReligionPsychiatry in SocietyPsychological Dimensions of the SelfPsychology and the MediaPsychopathia SexualisPsychopathologyPsychopathyPsychotic DepressionQuitting the Nairobi TrioRaising a Moody ChildRapid Cognitive TherapyRebuilding Shattered LivesReclaiming Soul in Health CareReclaiming the SoulRecollection, Testimony, and Lying in Early ChildhoodRecovery from SchizophreniaRecovery in Mental IllnessRedressing the EmperorRelational Mental HealthRemembering TraumaRepressed SpacesResearch Advances in Genetics and GenomicsRestricted AccessRethinking the DSMReviving OpheliaRewarding Specialties for Mental Health CliniciansSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSchizophreniaSchizophrenia RevealedSchizophrenia: A Scientific Delusion?Self-Determination Theory in the ClinicShunnedShynessSigns of SafetySilencing the VoicesSlackjawSocial Cognition and SchizophreniaSocial Inclusion of People with Mental IllnessSoul Murder RevisitedSounds from the Bell JarSpeaking Our MindsSpontaneous HealingStop PretendingStraight Talk about Psychological Testing for KidsStranger Than FictionStreet CrazyStudy Guide to the DSM-IV-TRSurviving Manic DepressionSurviving SchizophreniaSurviving SchizophreniaTaking Charge of ADHD, Revised EditionTaking the Fear Out of ChangingTalking Back to PsychiatryTarnationTeen LoveTelling Is Risky BusinessTelling SecretsThe Age of InsanityThe American Psychiatric Press Textbook of PsychiatryThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anger WorkbookThe Anorexic SelfThe Behavioral Medicine Treatment PlannerThe Betty Ford Center Book of AnswersThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Body in PsychotherapyThe Borderline Personality Disorder Survival GuideThe Broken MirrorThe Burden of SympathyThe Cambridge Medical Ethics WorkbookThe Case for Pragmatic PsychologyThe Center Cannot HoldThe Chemical Dependence Treatment Documentation SourcebookThe Chemical Dependence Treatment PlannerThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Condition of MadnessThe Construction of Power and Authority in PsychiatryThe Couples Psychotherapy Treatment PlannerThe Criminal BrainThe Cultural Context of Health, Illness, and MedicineThe Day the Voices StoppedThe Death of PsychotherapyThe Depression WorkbookThe Difficult-to-Treat Psychiatric PatientThe Early Stages of SchizophreniaThe Employee Assistance Treatment PlannerThe Employee Assistance Treatment PlannerThe Epidemiology of SchizophreniaThe Essential Family Guide to Borderline Personality DisorderThe Essentials of New York Mental Health LawThe Ethical WayThe Evolution of Mental Health LawThe Explosive ChildThe Fall Of An IconThe Fasting GirlThe Forensic Documentation SourcebookThe Forgotten MournersThe Gift of Adult ADDThe Good EaterThe Green ParrotThe Healing Power of PetsThe Heart of AddictionThe Heroic ClientThe Insanity OffenseThe Invisible PlagueThe Last Time I Wore a DressThe Limits of Autobiography The LobotomistThe Madness of Our LivesThe Mark of ShameThe Meaning of AddictionThe Meaning of MindThe Medical AdvisorThe Mind/Mood Pill BookThe Most Solitary of AfflictionsThe Mozart EffectThe Naked Lady Who Stood on Her HeadThe Older Adult Psychotherapy Treatment PlannerThe OutsiderThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Places That Scare YouThe Plural SelfThe Problem of EvilThe Psychology of Religion and CopingThe Quiet RoomThe Real World Guide to Psychotherapy PracticeThe Right to Refuse Mental Health TreatmentThe Rise of Mental Health NursingThe Roots of the Recovery Movement in PsychiatryThe Savage GirlThe Self-Help SourcebookThe Talking CureThe Trick Is to Keep BreathingThe Unwell BrainThe Virtuous PsychiatristThe Way of TransitionThe Wing of MadnessThe Wisdom in FeelingTheoretical Evolutions in Person-Centered/Experiential TherapyTherapy's DelusionsTheraScribe 3.0 for WindowsThis is Madness TooThoughts Without a ThinkerThrough the Looking GlassTo Have Or To Be?Toxic PsychiatryTransforming MadnessTraumaTraumatic PastsTraumatic Relationships and Serious Mental DisordersTreating Affect PhobiaTreating Chronic and Severe Mental DisordersTreating Self-InjuryTreatment and Rehabilitation of Severe Mental IllnessTreatment Plans and Interventions for Depression and Anxiety DisordersTwinsUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding DepressionUnderstanding ParanoiaUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnholy MadnessUnspeakable Truths and Happy EndingsUsers and Abusers of PsychiatryViolence and Mental DisorderVoices of MadnessVoices of RecoveryVulnerability to PsychopathologyWarning: Psychiatry Can Be Hazardous to Your Mental HealthWashing My Life AwayWhen History Is a NightmareWhen Someone You Love Is BipolarWhen the Body SpeaksWhen Walls Become DoorwaysWitchcrazeWomen and Borderline Personality DisorderWomen and Mental IllnessWomen Who Hurt ThemselvesWomen's Mental HealthWrestling with the AngelYou Must Be DreamingYour Drug May Be Your ProblemYour Miracle Brain

Related Topics
Social Inclusion of People with Mental IllnessReview - Social Inclusion of People with Mental Illness
by Julian Leff and Richard Warner
Cambridge University Press, 2006
Review by Tony O'Brien, RN, MPhil.
Oct 24th 2006 (Volume 10, Issue 43)

This book is a collaboration between two professors of psychiatry, one in the UK, the other in the US, so it provides the opportunity to explore issues in community care for people with mental illness from two perspectives. As the book shows, there are differences in the way community care has developed in each country, and there is much to learn from the resulting experience. Julian Leff has been a consultant to WHO and has published extensively on issues such as expressed emotion and outcomes of community care for people with schizophrenia. Richard Warner has worked in mental health service in Boulder. Colorado, an area considered to have introduced many innovative interventions in community mental health care. His Recovery from Schizophrenia: Psychiatry and Political Economy (1994) has recently been reissued, and he has collaborated with Paul Polak to develop a model of economic development for consumers of mental health services.

The book is divided into two main sections, the first on one of the major causes of social exclusion, stigma, and the second on one of the solutions, employment. Issues are addressed through discussion of concepts, and a review of related research. As in many areas of mental health care, there is limited good quality research, which means that on occasion the authors fall back on persuasive arguments in advocating various interventions. However they have gathered together an impressive range of evidence that should encourage funders and policy makers that the approach they advocate, social inclusion, makes both social and economic sense.

A theme that is apparent in several chapters is the comparatively better outcome for schizophrenia shown in developing countries, especially in rural settings. This relates to both main themes of the stigma and employment, although the reasons for differences in outcome are not fully understood. Compounding the distinction between developed and developing countries is the effect of social class: in developed countries working class people experience inferior outcomes to upper social classes, no doubt related in part to their disadvantage in the labor market. Interestingly, this latter observation confirms a finding of public health research, that over decades of public health intervention one outcome that has changed little is the relative disadvantage in health outcomes between social classes.

The issues of stigma, discrimination, work, and income are illustrated by pithy vignettes scattered throughout the text. These are first person accounts of an issue under discussion and serve to remind the reader that the issues debated by clinicians, researchers and policy makers are played out in the lives of real people. They keep the book focused on the issue at hand: people with mental illness, and their experience of health and social care.

The first section explores stigma, poverty and mental illness, with a particular focus on showing how mental illness requires a social model of understanding, not simply a traditional medical model aimed at symptom management, however important that might be at some points. The authors plead for greater public tolerance, willingness to question stereotypes and, importantly from the perspective of health professionals, the need to examine how professionals' stereotypes can contribute to stigma and exclusion.

The period of deinstitutionalization is shown to have unfolded differently on either side of the Atlantic, and to have heralded an unforeseen range of problems. This is a recurring theme in mental health literature, and this book reminds us how, against a background of institutional care, issues such as social inclusion looked rather more clear cut than they proved to be in the postinstitutional era. I have heard it remarked that consumer advocates of the 1970s have achieved everything they demanded: closure of the institutions, involvement in the governance of mental health services, influence at the highest political levels, yet still the call is for change. That anecdotal remark illustrates how much the social landscape has changed in the past three decades. Social Inclusion of People with Mental Illness indicates that there is more change afoot, as the aim focus for people with mental illness shifts to full citizenship rather than simply good mental health services.

In the section on barriers to employment Leff and Warner attempt to give empirical support and practical weight to advocacy that would otherwise be rights-based, and perhaps more likely to be resisted. By marshalling evidence on the impact of employment on clinical outcomes in schizophrenia, and by examining the effect of adjusting allowable income for beneficiaries, the authors are able to argue that what seems like the right thing to do for reasons of social ethics, also makes sense in terms of improved clinical outcomes and quality of life. The evidence is by no means definitive, but it does suggest that the argued benefits of social inclusion can actually occur when health and social policy are aligned. The authors review a range of employment programs, showing through this analysis the need to tailor programs to the needs of individuals, especially needs related to mental illness. For some this might mean retention of a revised form of the out-of-favor "sheltered workshop" model; for others it may be supported employment with a view to eventual participation in the competitive economy. The Italian "social firm" model of employment pioneered by Basgalia in Trieste is discussed in some detail in a separate chapter, which also traces its dissemination to other countries.

The chapter on innovative strategies begins by referring to what is an implicit commitment of the book, that "social inclusion" should lead to "full citizenship" for people with mental illness. There may be some readers who will feel frustrated that this philosophical position is not explored in some depth, but this is a brief book with a practical orientation. The intent seems to be to focus on what works, rather than explore the underlying theory. Of course there are potential pitfalls in such pragmatism, but if the book is taken in the context of the authors' larger body of work (especially Warner's Recovery from Schizophrenia) then there is ample explication of the theory behind the current work. A feature of the innovative strategies is the employment of consumers in providing both clinical and business services. Thus employment strategies converege with a frequently stated objective of the recovery movement, that clinical services can and should be provided, at least in part, by consumers of those services. Warner and Leff describe consumer run clinical services, clinical support services, housing ownership enterprises and business schemes. They discuss the potential ethical issues involved for both professionals and consumers in terms of issues such as boundaries and privacy.

The final chapter of the book covers consumer advocacy, with a section a the end on the recovery movement. Interestingly this section signals a possible rapprochement between advocates of the consumer focused recovery model with its emphasis on consumer empowerment, with more traditional psychiatrists who advocate evidence-based care. It will be interesting to see how that development unfolds. I felt that perhaps "recovery" was included a little late in the book, especially given the development of a recovery discourse which has a very different notion of recovery to the more traditional model of recovery that informs this book.

It is significant in terms of the current state of international psychiatry that medically trained consultant psychiatrists, steeped as they are in the traditions of their discipline, find it necessary to look to social explanations and interventions to problems of mental illness rather than biological theories. While much of psychiatry looks towards the promise of neurobiology, Leff and Warner look outwards, at the social conditions that shape mental illness, and the sorts of conditions that might make for a better life for the mentally ill. They do this without abandoning their commitment to medicine or psychiatry, and without aligning themselves with politicized movements based on challenging existing models of care. Social change, however, is what this book is about.

Social Inclusion of People with Mental Illness appears to be pitched at practitioners new to mental health, or perhaps looking for a plainly written overview to what used to be called "social psychiatry". If that is the case the book succeeds admirably. Much of the material has been extensively reported in various journal publications over almost two decades, and the book provides plenty of references for those who wish to pursue the original research and publications. It will be useful for mental health professionals, consumers, researchers and policy makers. For anyone wanting an introduction to the evolution of postinstitutional approaches to mental health care, and social interventions aimed at increasing inclusion this book is a great start.

 

2006 Tony O'Brien

 

Tony O'Brien, RN, MPhil. Senior Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz


Share

Welcome to MHN's unique book review site Metapsychology. We feature over 7900 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than thirty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Can't remember our URL? Access our reviews directly via 'metapsychology.net'


Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from Amazon.com for purchases through this site, which helps us send review copies to reviewers. Please support us by making your Amazon.com purchases through our Amazon links. We thank you for your support!


Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? Currently, we especially need thoughtful reviewers for books in fiction, self-help and popular psychology. To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716