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Book Review
Emergencies in Mental Health Practice: Evaluation and Management
Philip Kleespies
ISBN: 1-572302-55-0 1998 450 pages Guilford Press: London
Nicholas G Procter
Associate Professor, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide SA
In an era of individual mental health crises being more prominent across a variety of health practice settings, it is necessary to emphasise the importance of assessing and caring for such people. Perhaps the most difficult aspect of health care practice with distressed and disturbed people, is that they mainly access the health care system at the very point of their distress. With an informed knowledge base of background, treatment and safety issues, including appropriate follow up and after care, this book has a place. It is primarily about the assessment and management of people who are in severe mental distress, whether or not their predicament is capable of formal psychiatric classification. It is written from the perspective of the discipline of psychology, with more than thirty contributors that make up of nineteen chapters divided into four parts. Part I is entitled, Foundations; Part II, The Evaluation and Management of Life Threatening Behavior; Part III, Risk Management in Psychological Emergencies; Part IV, Emergency Related Crisis Interventions; Part V, Medical Conditions Presenting as Psychological Crisis, and Part VI, The Impact of Emergency Service on the Clinician.
Novice clinicians looking for instant solutions and explanations regarding the management of people they see in mental distress, this book may turn out to be a disappointment. While there are many fine and carefully crafted insights and comprehensive reviews of literature, the material presented in this work has a scholarly rather easy reading format. To make the work easier to read, the references to the sources of material could have been placed at the end of each chapter and not, as is often the case, alongside the sentence to which they refer. Nevertheless, the present format will encourage new graduates to discuss with their mentors selective aspects of emergency mental health interventions.
Experienced clinicians on the other hand, are likely to feel that this book will add considerable value to their practice style. The Emergency Interview (chapter 3) and Risk Management with the Violent Patient (chapter 10) stand out as being thoughtfully written with regard to providing sample ideas for interventions and policies and protocols for agencies to adopt as well.
It is, however, disappointing to see that nurses and nursing are largely absent from both the author list and sections contained within the work. A nursing voice could have strengthened this book by helping health care professionals identify their own prejudices and biases when working with people in mental distress, and what is suggested and inferred by them. Linkages between this and clinical situations are important as such perceptions will influence how a person is assessed and inevitably treated. By asking what are our own feelings towards people in mental distress? Do we fear or dislike them? Do they unsettle us? And if so, to what degree do we encourage and allow clients and their families to make decisions regarding the assessment and planning their care needs? Sensitivity in the way we ask our questions can be an opportunity for the development of a trusting and effective therapeutic relationship.
Nevertheless, this book can be regarded as an important reference for those working in mental health crisis intervention and generalist emergency health care settings.
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