January 2019 saw the publication by the UK Government of an inter-professional and multi-agency Consensus Statement on the Prevention Concordat for Better Mental Health, which has been three years in development. Its focus is cross-sector action, to increase ‘the adoption of public mental health approaches’. The new Oxford Textbook of Public Mental Health should become the standard reference book for trainees who want to adopt such approaches and especially for those who want to understand the evidence that underpins them. I recognise many of its UK authors from the Royal College of Psychiatrists’ public mental health network, but there is also strong global input, from every continent (except Antarctica).
The breadth of topics is impressive, from the expected epidemiological and aetiological material to vital areas that most other texts neglect (mental health in relation to housing or work). Secure housing reminds me of Dorothy's magical wish ‘there's no place like home’ from The Wizard of Oz. One of the key Marmot Review recommendations to reduce health inequalities was to ‘create fair employment and good work for all’, and future trainees should learn something about occupational mental health.
There are many fine chapters in this textbook, but in ‘The Social Determinants of Mental Health’, the suggestion for ‘tackling inequity’ really resonated with my own experience teaching Masters programmes in both public health and psychology: ‘work alongside… agencies with influence over green space and leisure, the psychosocial work environment, and the management of exposures to adversity, conflict, war and trauma’.
For trainees in psychiatry, there are practical sections, like ‘Interventions: Types and Places’, that cover the whole lifespan and societies with differing cultures or resources. In particular, the evidence for effective prevention of illness for different populations is presented with clarity and balance. One chapter that may prove a valuable resource for a wide variety of public health roles, from health visitor to hospital catering manager, covers ‘Diet, Environment, and Mental Health’.
In preparing this review, my hypothetical reader was engaged in UK professional training for the MRCPsych or MFPH qualifications, either as a trainee or a trainer. However, the developing field of public mental health extends much further than the UK. Consider two chapters that have international relevance: ‘Social Determinants in Low-Income Countries’ and ‘Treatment of Mental Health Problems in Refugees and Asylum Seekers’.
The authors of the chapter on low-income countries come from Bangladesh. Even here in England, the mental health needs of women exposed to violence figure frequently in my public health work. But in low-income countries, the widespread pattern of gendered violence means that women have much higher rates of anxiety, depression, suicide attempts and post-traumatic stress disorder than men. These women also have the least access to economic and professional resources. Compounding this gender inequality, low-income countries in South Asia and Sub-Saharan Africa are experiencing massive rural–urban migration. This rapid urbanization increases psychological distress for whole communities.
The authors of the chapter on refugees and asylum seekers come from Italy. They first consider professional engagement with a range of conditions (not just post-traumatic stress disorder but complicated grief and somatic symptoms). They then review the outcomes of 11 randomised controlled trials of treatment in six different countries for adults seeking refuge from a wide variety of conflict zones. In keeping with the rest of this textbook, culturally sensitive practice is promoted – for example, training refugees as counsellors who can offer Narrative Exposure Therapy to others. This chapter ends with a thoughtful reflection on preventing mental disorder among traumatised refugees: ‘I would love to see readers of this book develop new, upstream ways to prevent the conflict, victimization and trampling of human rights that drive so many millions to seek asylum, today’.
This book could enrich a variety of practitioners’ contributions to the UN's Sustainable Development Goals. It is probably too expensive (and detailed) for undergraduate students. However, I hope it will soon find a place in libraries for health professionals throughout the English-speaking world.