The Family Guide to Mental Health Care

Jun 24, 2013

If your practice or your advocacy efforts place you anywhere near people encountering the mental health system for the first time, please have a look at this book.

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A brief literature search suggests there is nothing published like this book. In any case, this one is comprehensive while remaining so welcoming; it is so authoritative and yet unintimidating, one need not look further.

The author is Medical Director of the New York Office of Mental Health, before which he was Mental Health Commissioner for New York City. The accumulated wisdom of these and previous years on the faculty at Harvard are evident throughout. Dr Sederer has a very direct sense of the needs of everyday patients and their families.

The section on medications, titled “What to Know, What to Ask,” provides an example of the author’s approach. It discusses how pharmaceutical companies influence the publication of clinical trials, and the impact of pharmaceutical drug detailing. The section emphasizes the importance of being an informed consumer and being prepared for a discussion of options with one’s doctor or nurse practitioner. The entire book is like this: a savvy yet fully academic, informed approach to getting the best possible care from the current poorly organized system of care (which an ED colleague of mine has termed a “non-system”).

Only one paragraph in the entire book disappoints: Dr Sederer’s lucid explanation of why one does not get an MRI to diagnose psychiatric illnesses is followed by an emphasis on how little we know about the causes of mental illnesses or how treatments work. Some might say that recent advances in genetics and molecular neuroscience support a somewhat more hopeful view of psychiatry’s grasp of causation and mechanism.

Amazon’s “Look Inside” provides the Table of Contents and the full Foreword by Glenn Close, who offers a personal example of why this book is so necessary. Have a look. Although there might not be anything particularly new here for a psychiatrist or psychiatric nurse practitioner, this book is useful for families.

Our current non-system of mental health care has no obvious door, nor does it have a personal guide to help a newcomer find appropriate resources or providers. Patients and their families have to learn as they go. With the Affordable Care Act (ACA; aka ObamaCare), however, many states are reorganizing their Medicaid programs. Some, like Oregon, hope to soon use the same system for Medicare and even for public employees. Perhaps here is a window of opportunity for mental health care to become more accessible, through the emerging “medical homes” the ACA advocates.

Such an improvement would add one more location where a patient could hope to find, in a better-organized mental health care system, piles of this book: not just in mental health centers and EDs, but in medical home lobbies as well. Surely Dr Sederer would regard this as a fitting thank you for his laudable efforts.

By Lloyd I. Sederer, MD; New York: WW Norton and Company; 2013 • 256 pages • $25.95 (hardcover)


Dr Phelps is Director of the Mood Disorders Program at Samaritan Mental Health in Corvallis, Ore. His Web site,, gathers no information on visitors and produces no income for him or others. He is the author of Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder (New York: McGraw-Hill; 2006), from which he receives royalties. Dr Phelps stopped accepting honoraria from pharmaceutical companies in 2008. He is the Bipolar Disorder Section Editor for Psychiatric Times.