Mental Health in Public Health: The Next 100 Years
This edited volume commemorates the 100th anniversary meeting of the American Psychopathological Association (APPA). Its title implies that the papers presented at the meeting and their publication would focus on the future, not the past. Most fittingly, the theme of the meeting was public health, as there "is not public health without mental health" (p viii). Dr Cottler, who edited this volume, was president at this centennial meeting and has put together a most forward-looking set of papers on public health for the 21st century. In her Prologue, she mentions that the first meeting, in 1910, focused primarily on dreams, their sexual symbolism, dreams as a cause of symptoms, and the mechanism of dreams. This meeting and this volume establish the direction that public mental health is the great new frontier for psychiatry. Rather than having a traditional public health focus on primary, secondary, and tertiary prevention, these papers emphasize current cutting-edge issues and research in public health and mental health.
The first set of papers, Part I, focuses on access to treatment in an era in which treatment has become more effective, in which epidemiologic studies have shown that two-thirds of individuals with serious and persistent mental illness have not received any treatment. The lack of access to treatment for individuals, families, and society is a major cost, especially when one takes into account the comorbidities of mental illness with very high cost medical conditions such as cardiovascular disease, HIV/AIDS, and cancer. Papers on disparities for minorities (especially Latino individuals) and addressing high-risk behaviors (with special attention to addiction) round out the first section.
Part II looks at the effects of war and disasters on veterans’ mental health and the mental health of individuals and societies exposed to violence. Additionally, there is an interesting chapter on addiction to drugs, food, gambling, sex, and technology, looking at potential shared causal mechanisms.
Part III focuses on public mental health from youth to old age. Adaptation and adjustment to old age is one of the major public health challenges of the 21st century as the population around the world ages. A related—and most important—chapter looks at the mortality from mental disorders and comorbid medical conditions. The excess mortality of individuals with mental illness is a major topic for research and intervention as we move forward into the 21st century. A final chapter in this section focuses on child mental health and is the only one in this volume that takes a close look at the question of prevention.
Part IV has a global view on the stigma of mental illness and includes a chapter on social determinants of mental health, once again reemphasizing the biopsychosocial model to which many of us adhere. On the issue of stigma, the question of collaborating with consumers of mental health services and their families in reducing stigma is a major recent innovation and one that should inform efforts in this direction. Social factors that have an impact on mental health include socioeconomic disparities and unemployment, violence, the degree of social support in communities, and the concept of social capital. The final chapter looks at an innovative community-based approach to include mental health in public health research called HealthStreet.
But the volume does not end here, but instead concludes with a series of short presidential papers starting with one by Al Freedman (APPA president in 1972) and then papers by 23 additional APPA presidents that provide a description of what they see as the future of the field. This group, a veritable Who’s Who in psychiatry today, has many interesting and often very different perspectives on what the priorities should be for research as well as treatment and prevention in the next 100 years.
It would be quite interesting to see, in year 2110, whether another volume like this one will be published, hopefully reflecting major progress in the understanding of the basic causes (biological, psychological, and social) of mental illness, providing a road map for the next 100 years for intervention and prevention.
Author affiliation: University of Maryland School of Medicine, Baltimore.
Potential conflicts of interest: Dr Sharfstein reports no financial relationships with commercial interests.
doi:10.4088/JCP.12bk07752
© Copyright 2012 Physicians Postgraduate Press, Inc.
