This very readable book is timely. Contrary to expectations, it is not just another book about feminism and mental health. Instead, Pauline Prior, who has clearly learned about life on the ground beneath the ivory towers of academic social policy units working as a social worker in both London and Belfast, seeks to shed new light on the problems that both men and women have in accessing mental health care. She explores the complex issue of gender and mental health in the context of our everyday world of changing mental health and social policy. This is both a strength and weakness of the work.?

Prior draws on recent epidemiological studies to argue that gender patterns in psychiatric morbidity are changing as problems associated with men (substance dependence and personality disorders) are more commonly being regarded as the business of mental health care. Men are also increasingly likely to be admitted to hospital. She asks whether this is due to “ increased state surveillance of this group as a perceived threat to public order” or to a real increase in mental distress among men. More research is clearly needed, but a picture emerges of care in the community in which women are more likely to seek early help and get treatment from their general practitioner while men, who find it difficult to express emotional distress, present later and are more likely to be referred. Subsequently, they may develop into those difficult, disturbed patients, well known to the services, who do not comply with treatment, pose a risk and are looked after in the community by elderly, often female, carers. Women, meanwhile, may find it difficult to access other parts of the system, such as services provided for people with substance misuse.

One of the best sections of the book shows how research on inequalities in health reveals that common generalisations about gender and vulnerability are not universally valid when ethnic and socio-economic circumstances are considered. Complex interactions exist between gender, ethnicity and access to services. For those living in a multicultural society the expression and recognition of distress are more difficult, as the discourses of the dominant culture (in which the psychiatric system is usually placed) may be different from those of the individual's ethnic group.

Those readers seeking generalisations will not, however, be disappointed. Psychiatrists are not mentioned among the potential readership on the back cover and this is perhaps not surprising although disappointing. It is a pity that statements such as “the debilitating side effects of most invasive medical techniques” creep into the text every now and then. This is particularly regrettable as the author chickens out of a consideration of how non-invasive techniques can be widely provided and indeed of discussion of the evidence of effectiveness of treatment for personality disorder or of whom will provide this treatment. American textbooks of psychiatry are quoted more frequently than their British counterparts, which get a brief mention in order to criticise the inherent sexism apparent in their clinical case examples.

Nevertheless, it is churlish to dwell on these points, which are minor. This is an ambitious book and would provide a good grounding in gender issues and mental health policy for psychiatrists who want to look beyond the perspective of their own profession and understand the broader policy environment. Herein, however, lies the book's main weakness. The sections on policy, law and crime are too superficial and do not knit well into the main text. I can sympathise with the author's dilemma in trying to discuss gender in context. However, she does not begin to discuss gender issues at all until page 43!

Overall, this book deals with issues that psychiatrists in training ought to know about and are not tackled well in standard texts. In her conclusion, Prior comments that in the 19th century, when the criterion of potential dangerousness was used to justify admission to asylums, men found themselves inside the mental health system, whereas in the 20th century, when the focus was on ‘illness’, men increasingly found themselves outside the system. Now, once again, we are being asked to focus on potential risk and admission rates for men are once more rising. Another case of back to the future?