Shulamit Ramon

The Impact of the Italian Psychiatric Reforms On North American and British Professionals

Professionals practising psychiatry in the US and the UK have reacted to the Italian psychiatric reform in a number of ways. This paper sets out to explore these responses in the light of the significance of the reform and its implications for these professionals.

British Approaches to the Continuing Care Client

This paper will focus on issues of definition and size, who is the continuing care client as an individual, the main policy and legislation changes introduced since 1980, the cost of, and innovation in, mental health services.

The Logic of Pragmatism in Mental Health Policy: The implications of the government position on mental health in the 1959 debate for the 80s

The Logic of Pragmatism in Mental Health Policy: The implications of the government policy on mental health in the 1959 debate for the 80s.

The implications of cultural construction of mental distress on psychiatric policies in Britain

Social policy is viewed as an outcome of political, cultural and professional demands, which may be in conflict at times (Hall et al., 1975). While the initial source of a particular demand may well come from outside the cultural sphere, it would need to be translated to that level for it to be socially legitimised and accepted. However, in this paper the focus is on the impact of cultural constructs concerning mental distress on shaping policy decisions in the psychiatric system in post-war Britain. This focus does not deny the fact that policies often influence cultural attitudes and concepts, as will be exemplified below. &dquo;Cultural construction&dquo; is defined here as the views and attitudes expressed in the media, in the arts and by lay people, as distinguished from those expressed by professionals. The reciprocity between cultural construction and professional conceptualisation is assumed by the author. The views expressed by politicians are perceived as occupying an intermediary position between cultural constructs and professional constructs. This is due to the role of the politicians as both reflectors and policy makers, who depend on both lay people and professionals for support and legitimation. This article is based on a study of parliamentary debates, professional writings, newspaper articles and television programmes. The point of historical departure for this text is the Second World War, until now the most profound period of social change during this century in Britain.

Book Reviews : COMMUNITY MENTAL HEALTH: PRINCIPLES AND PRACTICE L. Mosher & L. Burti Norton: 1988

This is a refreshing book about some of the most significant community care initiatives in Italy and the US, such as the Boulder Mental Health Centre, Dane services in Wisconsin, and Arezzo and South Verona in lt~ly, 1 hc authors apply a comprehensive and interesting set of criteria by which to evaluate mental health services and projects across the two country divide, incorporating statistical, demographic, and socioeconomic data with information derived from e.~-.~cv~ri~~w9, obserwations and written material. The reader therefore gets a vivid image of each place, and a sense of the underlying philosophy, the methods of operation and their strengths and weaknesses. Unlike most clinical texts the authors both of them well known psychiatrists with considerable experience in dchospitalisation and deinstitutionalisation programmes ― declare their interest in ensuring the success of community care, and do not hide behind a facade of being 5’waluc-frec&dquo;a However, one does not get the impression that their beliefs interfere with their evaluation of the different projects they describe, as the descriptions are full enough to enable the reader to make her/his own judgement, and the evaluation is consistent throughout the different services.

Book Reviews : TRIBUNALS ON TRIAL: A STUDY OF DECISION-MAKING UNDER THE MENTAL HEALTH ACT 1983 Jill Peay Clarendon Press: Oxford, 1989. Pp. 256. Hb. £27.00

Pcay provides descriptions of the process based on her observations, and the perspective of the medical officer , the client and the tribunal members. She attempts to outline the underlying logic of each of the main participants and how their contributions feed into the final decision Her approach to the different main actors is respectful and thoughtful, and the extracts from the interviews provide an interesting and useful insight into their logic and mode of presentation. Given the primacy of ensuring public safety, and the lack of duty to actively search for the least restrictive alternative, it comes as no surprise to learn that the majority of people who apply to the tribunals are not discharged. While providing a most thorough investigation, the author is consent not to ask the more fundamental question, namely that tribunal= seem to have been set up so that justice can be seen to be done rather than to ensure that people would be offered rehabilitation opportunities in the least restrictive environment. She does not ask why the law is not making it mandatory to look for alternatives to special hospitals or closed wards and whether in fact tribunals have been set up to fail, in having a predominantly legal function and not a rehabilitative objective. This book should be read together with that ofM. Barnes, R. Bowl, I~. Fisher: ’ ’ Seciioned° ° . RKP, London: 1989. The latter documents the results of a study which monitored the activities’ of social workers under the 1983 Mental Health Act in 43 local authorities, mainly around sectioning. Barnes’ book is located more within the social context in which social workers carry out their legal mental health activities, and not surprisingly its wider in perspective and more critica! than Peay’s study.