Mental disorders are common and costly. The World Health Organization estimates that untreated mental, neurological and substance misuse disorders account for 13% of the total global burden of disease. At present, unipolar depressive disorder is the third leading cause of global disease burden, and by 2030 will be the leading cause. In terms of disability burden, mental disorders already account for 33.5% of years lived with a disability in middle-income countries; this, too, is set to rise.
On this basis, public mental health is an urgent, important issue, and is certain to grow in significance in the decades to come. This new book, ‘Public Mental Health’, is eagerly awaited: it is the right book on the right topic at the right time.
This book's editor, William W. Eaton, PhD, is well placed to edit it: he is Sylvia and Harold Halpert Professor and Chair of the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health, and a highly accomplished, deeply respected figure in psychiatry. This new book reflects both his depth of experience and his academic expertise.
‘Public Mental Health’ is divided into six sections, the first of which deals with the ‘Nature of Mental and Behavioural Disorders’. This is probably the most engaging section of the book, and the chapter on the ‘Burden of Mental Disorders’ (written by William W. Eaton and several colleagues) is especially clear-sighted and practical. Paul McHugh provides a clear and thoughtful overview of the ‘Public Health Approach’ to psychiatry, and there is a useful consideration of ‘Global Mental Health Issues: Culture and Psychopathology’ by Judith K. Bass, William W. Eaton, Sharon Abramowitz and the ever-insightful Norman Sartorius.
Section Two of the book deals with methods and methodology, and includes considerations of the ‘Assessment of Distress, Disorder, Impairment and Need in the Population’ (Professor Eaton and colleagues) and an ‘Introduction to Quantitative Methods Especially Relevant for Public Mental Health’ (Elizabeth A. Stuart and colleagues). Section Three moves on to ‘Descriptive Epidemiology’ and looks at ‘Population Dynamics of Mental Disorders’ (Professor Eaton and colleagues), as well as the ‘Relationship of Adult Mental Disorders to Race, Socioeconomic Status, Marital Status, and Urbanicity of Residence’ (Silvia S. Martins and colleagues). This is an especially involving chapter, linking diverse risk and protective factors with patterns of mental disorders in adults: this chapter is a model of clear thinking on a complex topic.
Section Four examines ‘Mechanisms of Risk’ with particular focus on ‘Genes as a Source of Risk for Mental Disorders’ (Peter P. Zandi and Brion Maher) and the ‘Role of Executive Function Networks’ in ‘Mental Disorders Across the Life Span’ (Michelle C. Carlson and colleagues). There is also a valuable chapter on ‘Adapting To Acute Crisis’ (Carla L. Storr and colleagues). For me, the most compelling chapter in this section deals with ‘Models of Stress and Adapting To Risk: A Life-Course, Developmental Perspective’ (Catherine P. Bradshaw and colleagues). Life-course modelling of risk networks is a relatively new approach in psychiatry and appears well suited to the integration of disparate risk factors that act and interact in differing ways over time, resulting in multi-layered, time-sensitive models of aetiology. This is important.
In terms of mental health service provision, Section Five of ‘Public Mental Health’ looks at the ‘Behavioural Health Care Service System’ with chapters devoted to ‘Mental Health and the Law’ (Deborah Agus) and ‘Pathways to Care: Need, Attitudes, Barriers’ (Ramin Mojtabai and colleagues). For readers interested in mental health systems in the United States, there are chapters on the history and programmes of ‘Community and Public Mental Health Services in the US’ (Anita Everett and Su Yeon Lee) and a more focussed ‘Perspective through Care Patterns for 100 Adults, With Aggregate Facility, Service and Cost Estimates’ in America (Ronald W. Manderscheid and colleagues).
Mental health care in the United States is a very diverse affair, with certain services achieving extremely high-quality care, but also a steady stream of evidence about individuals with severe illness failing to access the care they need. This book balances its consideration of the US situation with a chapter on ‘Mental Health Systems around The World’ by Shekhar Saxena and colleagues, providing a good overview of differing approaches across the world.
Finally, ‘Public Mental Health’ devotes its closing two chapters to the themes of ‘Prevention and the Future’ (Section Six). More specifically, Tamar Mendelson and colleagues discuss the ‘Logic and Practice of the Prevention of Mental Disorders’ and Phillip Leaf and colleagues conclude that there is ‘Progress Made, But Much More to Be Done’.
This is most certainly true: some progress has been made, but public mental health is an issue that needs to be repeatedly re-visited, re-thought and, when necessary, re-invented.
To this end, ‘Public Mental Health’ is an important, timely book. It is clearly written, well structured and puts mental health firmly to the forefront of the public health agenda, where it rightly belongs. There is much to be done.
Declaration of Interest
None.
