Indian Journal of Medical Ethics

Mental disorders account for nearly 12.3% of the global disease burden, estimated to increase to 15% by the year 2020 (1). Much of this increase is likely to happen in developing countries that are least prepared to deal with it. Due to paucity of financial resources and the time taken to train professionals, developing countries are unlikely to see substantial short-term increases in the number of mental health professionals. Although effective interventions for many mental disorders are available, only a minority receive treatment from mental health services (2). The World Health Organization therefore recommends integration of mental health services into primary health care as a strategy for increasing access to mental health care (3). Training primary health care staff in mental health care is both a challenge and an opportunity.

Where there is no psychiatristattempts to address this training issue and is likely to be of greatest use in the developing world. It draws inspiration fromWhere there is no doctorby David Werner and other books of this genre. As the author says in the preface, there are no practical, clinically oriented mental health care manuals designed for general health workers. He correctly identifies the increasingly complex and technical language of psychiatry as an important obstacle to improving access to mental health care. This book attempts to break down the wall that psychiatry has built around itself.

The manual is divided into four parts. The first part provides an overview of mental illness with guidelines for assessment and treatment. The second deals with clinical problems using a problem-oriented approach as opposed to the traditional diagnostic-based approach. The third provides guidance on integrating mental health, including addressing the mental health needs of vulnerable populations such as refugees and persons with HIV/AIDS, and guidance on promotion and advocacy. The final part contains reference information for common problems.

This comprehensive manual uses illustrations and case studies liberally. It is easy to understand and is interesting without being simplistic or too lengthy. It covers the usual behavioural problems along with neglected topics such as domestic violence, and sexual and psychological abuse. I was, however, disappointed to see little coverage of psychotropic medications, which if used appropriately, are a cost-effective intervention for many common mental disorders. Primary-care clinicians are either unaware or wary of modern psychotropic drugs and continue to prescribe older ones, which generally have more side-effects that affect patient adherence.

The presentation could be improved. Bulleted lists make it easier for the reader to understand but several such lists actually worsen comprehension. I would have liked to see some training lectures and presentations. Those training primary-care staff would probably appreciate ready-made presentation materials-an outline of a training programme, necessary slides and work exercises.

The sheer comprehensiveness of the manual and the presentation format used may leave the manual sitting on library shelves. That would be a shame because even with all its shortcomings, the book is extremely well written and probably the only such resource book on this subject. The review copy I received did not mention the price. I hope that it is affordably priced for the average primary-care worker in a developing country to own his/her own copy.

References
1. Murray CJL, Lopez AD (eds). The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 projected to 2020. Cambridge, MA: Havard School of Public Health on behalf of the World Health Organization and World Bank, 1996.
2. World Health Organization. The mental health context (Mental health policy and service guidance package). Geneva: World Health Organization, 2003.
3. World Health Organization. Organisation of services for mental health (Mental health policy and service guidance package). Geneva: World Health Organization, 2003.