Mental Health for Primary Care: A Practical Guide for Non-specialists

Mark Morris
Radcliffe Publishing, Oxon (2009)
Paperback, 204 pp.
ISBN: 978 184619 271 5

The author of this book illustrates considerable knowledge in the area of mental health, covering topics and issues surrounding various health problems that may present in primary care. The author’s personality shines through in the book with light humour, for example the comment ‘… I later realised I had been interviewing the wrong person’ (p. 37).

Divided into four main parts, the material covered in the book is wide ranging. Part 1 of the book focuses on foundation issues of causation to include vulnerability and resilience through to precipitating factors that can provoke the onset of illness, while part 2 of this comprehensive text details the management of common problems found in primary care.

From early in the book, terms of reference are clearly defined to minimise any misinterpretation (as illustrated by outlining terms such as ‘heritability’ in the foot notes, p. 8). However the author often neglects to reference varying statistics or many key terms to allow the reader to conduct further interpretation and analysis. As example, this is evident on p. 8 under the subject of genetics where statistics are noted but no references follow. There are also limited reference materials, particularly when discussing issues such as drug dependence syndrome (p. 53) or when statements are made concerning ‘there is good evidence…’ but no evidence is suggested (p. 56).

Sometimes presented information is perplexing, leaving room for possible misunderstanding. For example, the author states ‘… the attachment figure is usually someone who has had a lot to do with the baby in terms of play and comforting; feeding is not the crucial element and breast or bottle feeding is simply irrelevant’ (p. 10). Does this imply that other significant people can have equally fulfilling attachment towards the small child and not just the biological parents, or is the author suggesting that mother–infant attachment is not influenced, whether breast fed or bottle fed, or that mode of feeding is not important?

While the author appears well informed and details are implicit, there are instances when further explanation is necessary for the reader. For example, a statement reads ‘Transmission [Hepatitis C] by the sexual route is rare but may be increasing’ (p. 55). We can make our own assumptions; however, it may be useful to read the author’s rationale for this statement, and perhaps also to understand the social trends of this phenomenon. If these issues had been framed in a socio-environmental context the practitioner would have better overall understanding potential complexities, allowing forecast of possible obstacles to rehabilitation.

The author uses his own case study experiences to illustrate possible techniques when consulting. An example is highlighted during chapter 7 where a case study of a patient with low mood is included to help explore the recognition, assessment and management (p. 72). This concept is potentially beneficial to the reader by putting a condition into a context; however, because the author discusses other features of depression in general terms and later reverts back to discussing the case study the effect is one of confusion. Perhaps if the case study was appropriately boxed like the other examples (pp. 85, 113) we could easily recognise this and not be confused about who ‘she’ is on subsequent pages.

Continuing the mood theme, in chapter 7 the author examines other mood problems, such as postnatal depression (PND). The book addresses PND as a main cause of maternal death in the first year post partum; however, it does not review possible causes or how to address this with a new mother presenting with emotional difficulties in general practice or how to recognise the signs. Clearly becoming a parent is a huge life event to adjust to, but in primary care, how does the author suggest we approach the issue with this vulnerable sub-group?

One section of the book deals with the dependency problems of alcohol and drugs, featuring details such as symptomatic treatment for opiate withdrawal, and treatment planning, as well as detoxification in the community (p. 56). While very informative, this appears to drift from psychological issues to pharmacological. General practitioners who regularly deal with drug-dependant patients may benefit from the inclusion of more social matters, such as how to maintain patient contact. Why is it many patients regress and how can we help them in general practice?

While the amount of information is at times overwhelming, particularly in part 2 of the book, the subsequent chapters 11, 12 and 13 include sound practical frameworks containing psychological tools that are invaluable. They can be utilised by any primary health care professional from maternity care through to those working with older adults in varying health disciplines. The non-specialist can develop effective communication techniques and be well equipped to provide reflective and constructive feedback when consulting.

The book is written from a European perspective, making it difficult to unconditionally recommend this book as a global text. One example, in Table 1.1 the author outlines the characteristics of a ‘difficult child’ with one point in particular making reference to Mediterranean mums (p. 9), which probably needs local context as from an Australian perspective this seems almost to have racist overtones. Another example, the book includes information regarding seasonal affective disorder, specifically detailing the months of a rise in symptoms as December to February, which does not relate to countries such as Australia (p. 81) – a term such as ‘midwinter months’ would have been more appropriate. The support agencies the author suggests patients contact, such as Victim Support (http://www.victimsupport.org) and Ex-Services Mental Welfare Society (http://www.combatstress.org.uk), are based in England.

When discussing some examples of mental health state examination findings, under the title of depression, metaphors are applied from the English children’s story Winnie-the-Pooh (p. 37). In this instance, I feel it may have been more meaningful and realistic using examples from the author’s own experiences and consultations. As for navigating the text, the indexes, appendices and glossaries are not only complete, but very practical. However, the book also contains many grammatical errors.

Overall, the author has attempted to create a comprehensive text utilising the expertise of many other well practiced health professionals to provide a good overview of the varying problems faced in general practice. Perhaps a second edition could expand on the socio-environmental trends of mental health and other associated problems, while also exploring the issues around maintaining contact with patients following the initial consultation. After all, you can’t always rely on a patient’s word that they will come back no matter what interview technique is employed (as discussed in chapter 12). This is especially the case when working with patients suffering chronic mental health conditions or those coming from dysfunctional backgrounds.

A second edition of this book could amend these problems making it an informative, well rounded and practical student or graduate health textbook to guide and support those intending to work in general practice.

Melissa Buultjens
School of Public Health
La Trobe University