Improving Mental Health Care: The Global Challenge is not only an excellent read on the difficulties facing world mental health over the next decade, but also a demonstration that a life-time career dedicated to psychiatry can truly revolutionize clinical and cultursal practice. For those who, like me, attended the Festschrift event to honour Professor Tansella, which forms the basis of this book, there was no surprise in noticing the calibre and international reputation of the contributors to this book, and in reading the warm dedication that the editors (Ruggeri, Thornicroft and Goldberg) have dedicated to this giant of Italian psychiatry, who has imported the Anglo-Saxon model of evidence-based medicine (and merit-based academic progression) to the now world-famous ‘Verona South’ mental health services.
The breadth and depth of topics covered by the book is impressive, and matches the complexity of the ‘global challenge’ that is mentioned in the title and that is described so clearly in the first chapter, written by the editors: the clear-cut discrepancy between high- and low-/middle-income countries, and in resources dedicated to mental health, including to mental health research, is exacerbating health disparity across the world.
The book is divided into four main sections: the description of the global challenge; how to meet the global challenge; new research methods; and better care delivery in the community.
The first section, on the challenge, has, in addition to the introductory chapter mentioned above, three chapters focused on ‘resource’-poor setting, the UK, and the concept of recovery. This last chapter is particularly fascinating in the explanation of this complex psychosocial and clinical concept, and includes an extensive semantic section.
The second section, on meeting the challenge, is the longest, with a total of nine chapters on topics as varied as the development of new models of care for low-/middle-income countries to the training of mental health providers. The last chapter on the ‘economic case’ for better mental health discusses important concepts such as efficiency, equity, cost-effectiveness and utility. With many national health services across the world experiencing substantial expenditure cuts, even in high-income countries, understanding these concepts is crucial to optimize the interface between ‘commissioners’ and ‘providers’.
The third section, on new research methods, has seven chapters, and the book delivers up-to-date and innovative knowledge. The take-home message here is that research methods in epidemiology are changing and changeable, as adaptable to new challenges as other experimental and medical approaches. Different methods give different information – and even biological research can inform epidemiology. Users' contribution is becoming paramount in research planning, and this is yet another area of medicine where psychiatry has led the rest of the specialities.
Finally, the fourth section, on the delivery of services in the community, has five chapters, including one from a past president of the World Psychiatric Association (Sartorius). This chapter in particular describes some ‘wobbly planks’ in the platform: the lack of psychiatrists in the world, the excess of stigma, the difficult transition for professionals moving from institutional to community care, the absence of support for families, the difficult division between ‘primary care’ mental health and ‘specialist’ mental health … and many more wobbly planks.
This book may be celebratory of the role of Michele Tansella in world psychiatry, but it is certainly not celebratory when discussing the challenging reality of mental health care and research in the 21st century. If you read this book, you will be better prepared to address these challenges in your own clinical or academic activity.
