I found this book to be a bit of a long gripe at times, but nonetheless a salutary one. Before embarking on it I kept in mind three questions: Will it provide comfort/advice/guidance to other carers? Will it make mental health professionals more aware of the plight of the carer? Will it offer insights on what carers actually need in terms of support? The answer to all three questions is yes, in parts.

The book relates a 20-year history of a father not only struggling to come to terms with his son's schizophrenia, prompting guilty, soul-searching questions, but also having to cope with the idiosyncrasies of the caring system, which apparently often failed both him and his son. Father deserves admiration for the courage, resilience and sheer utter resolve not to abandon a son in distress, even when he behaved in an appalling, bewildering and risky manner, living between the extremes of ‘constant worry, increasing anxiety and heart-in-mouth horror’. Salmon describes the incomprehensible institutional routines, the Kafkaesque bureaucratic system, constant changes in policy and personnel, and the ‘impersonal system of care’, which fails to take into account the inability of a person with a mental illness to navigate its forms and procedures, constantly fails to deliver despite good intentions and high-sounding but empty rhetorical words (consultation, empowerment, normalisation, accessibility, flexible pathways, well-being agenda, therapeutic optimism, preventing revolving doors, early intervention, social inclusion) and, in the words of the author, all that ‘brouhaha’. More often than not he was left having to do all the provision himself.

In terms of ideas helpful to services Salmon does offer some insights. He stresses the need to involve carers more effectively when drawing care plans that are feasible and implementable, an awareness that people with schizophrenia are particularly sensitive to defensiveness, insincerity or discomfort in staff and more likely to react in a violent or bizarre manner when faced with uncaring professionals, and the need for straight and frank communication when establishing a prognosis and therapeutic hopes.

Although at times I was uncomfortable at his comments expressing a hint of resentment against other ‘creeds and races’ (both patients and staff) who often populate admission wards and poor estates, and the deference he showed the medical profession as opposed to other mental health workers, I do agree with the overriding message that we have a long way to go to work alongside carers in a mutually sharing system of care. I would recommend this book for care coordinators and those interested in more responsive and engaged services.