Book Review: Mental Health Policy and Practice
| Published date | 01 March 2007 |
| DOI | https://doi.org/10.1108/13619322200700012 |
| Date | 01 March 2007 |
| Pages | 47-48 |
| Author | David Kingdon |
| Subject Matter | Health & social care |
tis very difficult to write a book on
mental health policy which is well balanced, fully
referenced and broadly comprehensive. Most of the
relevant sources are ‘grey’, not cited in the usual
databases, and so readily missed or discounted by
researchers not intimately involved in the field. There
are also few texts available from which to draw a
consensus view as many of the previous books in this
area have been heavily influenced by specific
perspectives, in particular anti-psychiatry, anti-
government (red or blue) or anti-community care,
counter-balanced by the very frequent Department
of Health publications designed to promote specific
policy initiatives, now so supported by the internet.
Lester and Glaser have generally negotiated a trail
through and around these contrasting viewpoints,
incorporating those for which a reasonable level of
evidence exists and commenting on those of influence
even where evidence is limited.
Some areas might have been further explored.
Mental health policy exists within a context where
local and central control has vacillated over the past
few decades. The establishment of the prioritisation
of mental health in the seventies under Richard
Crossman through to the Health of the Nation in the
early nineties was a period wherelocal decision-
making and implementation championed by
government limited the impact of prioritisation. More
centralist ‘tsarist’ NHS Plans in recent times have
been unpopular with local commissioners and many
practitioners but have delivered resources, albeit for
specialist teams, which may have distorted local
priorities, especially in rural areas. The pendulum may
be swinging again toward primary care commissioners
making the key decisions affecting mental health in
the futurewith uncertain consequences for current
services to people with severe mental illness.
Treatment developments might have been influential;
I
The Mental Health Review Volume 12 Issue 1 March 2007 ©Pavilion Jour nals (Brighton) Limited 2007 47
Book Review
the wave of new drugs for depression and psychosis
over the 1980s and 1990s have certainly influenced
policy and views of mental health – the ‘Prozac
revolution’. How much influence they have had on the
prognosis of individual patients is less certain; for the
former group, drugs are certainly safer and for the
latter group the newer drugs have different side-
effects from the older drugs. And what about the
influence of the pharmaceutical industry? Policy on
the availability of new drugs, the financial implications
involved, and the direct effects in supporting health
promotion programmes and the more indirect effects
on advertising effective treatments for mental health
problems have all had impacts on service provision
and medical and public perception.
The significance of the revolution in research into the
effectiveness of psychological interventions across
diagnostic groups has also been substantially
demonstrated through its influence on guidelines from
the National Institute for Health and Clinical
Excellence. Making such treatments available has
been much more of a problem – there is no equivalent
of the drug industryto promote them. This is now
being recognised by government and the media.
Beyond the immediate impact on individuals, these
developments may also have a major effect on how
mental health conditions areunderstood, described
and classified. There is also the paradox mentioned by
the authors that social carecan end up relatively
devalued as so little research investigating its specific
evidence-base is currently funded.
Significance can be difficult to assign to
developments that may be strenuously advocated by
interest groups, including politicians and the
Department of Health, but ultimately are scarcely
noticed by practitioners. Fashions come and go as
much in this as in other policy areas, if not more so.
Evidence supporting policy initiatives is frequently
Mental Health Policy and Practice
By Helen Lester and Jon Glasby
Basingstoke: Palgrave Macmillan (2006)
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