Some time ago, while teaching an MRCPsych course about family influences on psychiatric presentations, I discovered that very few of the trainees had ever witnessed a family interview, which was generally seen as the province of child psychiatry. Shortly afterwards, the teenage sister of a young woman with schizophrenia unexpectedly hanged herself. The staff team sifted through the possible explanations for the link between the sisters' mental states and how the suicide might have been prevented by the younger girl's greater involvement in her sister's management. Had she been adequately included in discussions about the possible causes of schizophrenia, its likely course, the risks for others in the family and so on?
This book arose out of a conference held in 1998 called ‘Interfaces between child and adult mental health’. It aimed to acknowledge the mutual interaction between children and parents, to recognise the various ways that children's and adults' problems overlap and to consider implications for service delivery.
As the editors state, there are a number of theoretical and practical reasons why psychiatry has emphasised the differences between age groups rather than their interrelationships. These include differences in the theories and knowledge bases that dominate the specialities, the organisational structure of services and the way professionals are trained. The authors cite the example of a single mother with depression who has a 7-year-old child with a profound sleep disturbance. How likely would it be that the management of both would be fully integrated?
In many ways this book is much better than most publications of conference proceedings. Each chapter has been carefully edited and the result is an easy-to-read, uniform style with lots of clinical examples. Extra sections have been added to cover topics not included at the conference, many from highly regarded experts. Most importantly, a section on service developments provides six illustrations of attempts to involve children in the management of their parents' mental health problems and of effective liaison between child and adult services. Finally, a section on future directions proposes ways to address the interfaces and integrate service delivery.
The result is a very important book for psychiatrists across the life span, with a number of ideas for service development.
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