Robert Drake and his colleagues
have been prime researchers in evidence based practice for some time and have
helped define its place in mental health. This publication is intended to be a
text book, but not of the encyclopedic variety. Rather it provides short,
crisply written chapters that serve as an introduction to the best available
evidence in mental health practice and how to make that judgment. It is not
directed at any one profession — the editors are a physician, a psychologist
and a social worker (but not it may be noted, any nurse) — but at mental
health practitioners.

While the reader will not find an
exhaustive consideration of the clinical signs and symptoms of mental
disorders, there is much sound advice about what to do, and how to do it. It is
particularly useful in the community setting, and in the care of those with a
severe and persistent mental illness.

Step by step the reader is led
through the principles of community mental health concepts and practice to the
principles of evidence-based practice and clinical decision-making. The authors
seem to recognize that although it may be widely acknowledged as a core value,
actually deciding what is, and what is not, evidence-based practice is a little
more difficult than it looks. The chapters that deal with the evaluation of
research evidence and research techniques and methodologies are among the
clearest and most helpful in the book although some might complain, with some justification,
that they tend towards the quantitative side of things to the exclusion of the
qualitative. However, these chapters alone would act as a solid, if limited,
primer in research evaluation.

There are helpful chapters on how
to evaluate the evidence, and how to apply it. Although there is some diligent
research behind the book, the presentation is not obscure, but straightforward
and often built around client scenarios and histories, almost as though the
clinician was presenting a case to peers. Perennial clinical problems, like
compliance with medication, are used to trigger the discussion. Clinicians know
that this is a real issue, but traditional text books tend to ignore the
problem, or treat it insufficiently well. It is a great virtue of this text
that it keeps its focus very clearly on such things. It is not enough to speak
in vague terms about insight or a therapeutic relationship if they cannot be explained.
This book does its best to explain the evidence that will support interventions
for clients who are reluctant or refusing to take medication. This orientation
is probably the prime reason why it will appeal to clinicians.

Most of the common approaches to
care are covered well. There are good sections on medications and psychological
interventions, including psycho-education, that are designed to maintain a
person in the highest state of health with the maximum of autonomy and
self-reliance.

Some, of course, may find the tone
a little too pat, a little too simplistic, but if it judged for what it sets
out to be, the text often succeeds admirably. It is best thought of as an
introductory text, and not one for advanced practitioners or researchers
(although all readers will find something of value).

There are still areas of mental
health care that are not covered as thoroughly as might be imagined. Although
cultural-competence is discussed, the more specific concerns of migrants or
refugees are not. Early intervention and early identification strategies, which
have often seen to offer a great deal of hope in recent years, are not
sufficiently examined. The move towards primary health approaches, partnerships
and shared care arrangements, mental health literacy and mental health
promotion are somewhat under-developed, although the chapters on assertive
community treatment and supported employment are welcome. The role of the
consumer movement and the role of the family (apart from what clinicians may do
to or for them) on the other hand is an area of deficit.

The book would not be able to stand
alone on a clinician’s bookshelf. There is much in the detail of the experience
of mental illness that it does not cover. However, it does address in a straightforward
and accessible manner some of the major challenges facing mental health
services in their struggle to implement evidence-based practice. The big
question has always been not so much what to do, but how; how to implement the
best practice we can, how to know that what we are doing is as effective as it
can be, how to put the theory into practice. And that is a question this book
attempts to confront. It is a most welcome addition to the literature.

© 2006 Mark Welch

Mark
Welch, Ph.D. Assistant Professor in the Faculty of Nursing at the University of
Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating Centre
for Nursing & Mental Health.

Categories: Psychology