Dr Loir Raney and colleagues have compiled and presented a substantial review of the existing literate and supporting data set in the emerging field of integrated behavioural health and primary care, making a compelling argument to further expand this novel approach. Chapter 1 introduces the reader to the concept of collaborative care (CC) from core principles onwards, citing an objective evidence-based view of the status quo in the management of mental health in the primary care setting in the USA. Chapter 2 introduces the novel concept of utilising a behavioural health provider (BHP) as well as the roles of the remainder of the CC team. In pragmatic terms, this can be crudely considered as a way of delegating the resource heavy element of history taking to the BHP. Raney takes time to work through this model form concept to well-referenced trials. This is perhaps the most radical concept introduced in the book, yet from a macroscopic view it seems wholly sensible. As practical questions arise in the readers mind, they seem to be sequentially addressed by Raney. Chapter 3 focuses on the role of the consulting psychiatrist, while chapter 4 offers a nuanced view into the role of collaborative care in providing paediatric mental health services. This is of course poignant at the time of writing in Ireland, as there are major shortcomings in this service. Chapter 5 deals with the subspecialty of risk management; here Lambert and Bland introduce the concept of ‘split treatment’, ‘hybrid’ and ‘blended roles’ and the associated liability issues that may accompany the same. Chapter 6 is a succinct walk through of the many institutional issues that psychiatrist training in this area may require. In this respect section I deals with a great deal of nuanced information, yet effectively introduces context and concept, right through to the practicalities from practice management to academia.

Chapters 7 through 10 encompass section II, with chapter 7 focusing on behavioural health. A cursory nod is given to the importance of exercise and nutrition as well as other social determinants of health such as substance misuse, tobacco and medication side effects. This chapter acknowledges that the psychiatrist may be the only healthcare professional a patient with serious mental illness may encounter. In this respect, perhaps more time should be devoted to the role of nutrition, not just as associated trigger for morbidity but also as a causative factor in mental and behavioural illness. The underlying message here is strongly tethered with the shocking 25-year gap in mortality for patients with serious mental health illness. Chapter 8 delves deep into the weeds of how the proposed model works at a “curb-side” level and is notable for its intricacies and attention to detail. Behavioural health homes are described by Parks in chapter 9 and, like chapter 8, offers an in-depth review of how this model can be practically applied. Chapter 10 is devoted to dealing with cardiovascular risk, with each aspect of metabolic syndrome addressed, with convenient clinical pearls included. Vanderlip and Chwastiak present a concise review of a topic that could easily fill several tomes on its merits.

The text of this book is impeccably referenced, and as pragmatic questions to the primary care provider arise, they are appropriately addressed by Raney and co-authors. The text is pleasantly spliced by real-time examples, trials of varying size and quality and also comments from those who have participated in CC. The case vignettes bring together the evidence base and the real-world practicalities succinctly, and they are a welcome addition. Raney and colleagues cite savings to both state and insurance providers alongside improved patient outcomes, which only serves to add impetus to the proposed model of care put forward. The only detraction to a European reader may be the frequent references to American healthcare models, which are fragmented and in a constant state of flux at a federal, state and insurance provider level. However, gaps in access to care, be it primary, tertiary or integrated, are seemingly universal, as is Julian Tudor Hart’s inverse care law, whereby those who require these services most are often those that can access them the least. In the current healthcare climate, chapter 4 should be sought after alone for guidance as to how to deal with the very real dilemma facing the future mental health of our paediatric population.