Reviewed by STEVEN S. SHARFSTEIN, MD
As care for the mentally ill has shifted from the institution to the community in the past half-century, families have become the most critical component for care and recovery. It is in the context of the family that a mental illness is first recognized. It is the family that bears the largest financial burden for their ill family member, often over many years. It is the family that must navigate the broken mental health system, fills in the gaps, and provides sustaining essential support for their loved one. We know that relationships matter for mental health but, for serious and chronic mental illness, family relationships are most often the essential component for recovery.
Lloyd Sederer is the Medical Director of the New York State Office of Mental Health, one of the largest departments of mental health in the country, and is the Medical Editor for Mental Health at the Huffington Post. He is the rare combination of public health expert, teacher, and writer and has put all of his skills together in this superb volume, The Family Guide to Mental Health Care: Advice on Helping Your Loved Ones. It offers a comprehensive perspective on mental illness and its treatments, presents a road map for coping with the fragmented mental health system, and most important, provides concrete advice on how to talk with a loved one with mental illness and how to advocate for proper treatment and care.
The book has 11 chapters and three appendices. Chapter 1, “What Families Can Do,” underscores the main theme of the book, empowerment of families. Hope comes through knowledge. The author brings his skills as both clinician and writer to the fore by providing, in lay terms, facts about diagnosis and treatment (chapter 2) and how to access and evaluate good care (chapters 3–5). Chapters 6–8 delve more specifically into the state of the art in diagnosis and treatment, focusing on psychopharmacology in chapter 7 and psychotherapy and rehabilitation in chapter 8. Chapter 9 deals with financing of care and chapter 10 with involuntary commitment and the law. Chapter 11 is a ringing endorsement of the concept of recovery built on the hope and reality that individuals with mental illness can lead full lives. In this volume, a psychiatrist recognizes the immense value of peer support services, a relatively recent innovation in the mental health treatment system.
This is one of the best and most practical guides for families. It will also be extremely useful in helping clinicians (physicians and other professionals) understand how to work with families and the lay language they need to use to empower families to be treatment extenders in many different settings. By language, I mean both empathic interventions and giving the best advice. There has always been concern about giving advice in psychotherapy, but advice-giving is an essential component in supportive psychotherapy. The specifics for families provided in this book have a scientific base, and families can rest assured that Dr. Sederer’s advice is state of the art.
This book has few deficiencies. The chapter on paying for care does not discuss how the burden on family finances posed by a serious and persistent mental illness affects long-term family functioning, how the family decides what to allocate and when, the right questions to ask about recommendations that could stress family finances, and setting limits. The author does discuss the ABCs of Medicare, Medicaid, private insurance, and managed care, but financial issues go beyond third-party payments and can cause longterm severe stress for families.
This book would be of value to consumers of care, both patients and families, as well as to trainees and young clinicians embarking on practices that must include not only individuals in need but also interventions with families.