Richard Warner is well known for his contributions to social psychiatry, both theory and practice, and for innovations in the mental health services in Denver, Colorado. In this short and stimulating book, he reviews the state of knowledge of some important aspects of schizophrenia and proposes 13 interventions. The first of these would lower the incidence of this condition, while the other 12 would reduce the disabilities and promote the abilities of those having to cope with it — the patients themselves and their social and therapeutic circles. His straightforward style is clearly aimed at a wide readership: the people who might be involved in initiating, encouraging or carrying out the interventions.
The 13 proposals are focused on three different ‘levels’: the individual (five), the domestic (three) and the community (five); and are as follows: (1) an educational campaign on the risk of obstetric complications, which for various reasons are particularly common in mothers with schizophrenia; (2) individual substance misuse counselling (which goes against the punitive approach adopted in the USA towards illicit drug users); (3) cognitive—behavioural therapy for psychotic symptoms; (4) the proper use of benzodiazepines to reduce stress-induced psychotic symptoms; (5) consumer involvement at all levels of service provision (some striking examples are given); (6) tax-free support payments for caregivers (landlords and foster-parents as well as families); (7) marketing of the family psychoeducational approach; (8) domestic alternatives to the hospital for acute treatment; (9) expansion of social firms — businesses employing consumers; (10) modification of disability pension regulations to increase the allowable earned income level; (11) provision of wage subsidies; (12) lobbying the news and entertainment media, as part of (13) a global anti-stigma campaign — which incidentally takes you back to (1), as people with schizophrenia often get a raw deal from our medical colleagues for all their many physical conditions.
Sounds interesting? Well it is. Warner's breadth and depth of vision and his positive approach are most refreshing. He provides cogent arguments and background information for all of his proposals. Many of the most ‘radical’ interventions, for example those on consumer involvement and domestic alternatives to hospital for acute treatment, are based on what has been achieved at Denver.
This is a book not for the library, but for the table, desk or pocket. After you have read it, the workaday landscape seems a bit different and full of opportunities.
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