Book Relliews 107
Prevention In Community Mental Health Centres, Hess Robert E and Morgan John
(eds), Haworth Press, New York, 1990 (I38pp, US$24,95 hbk, ISBN 086656999 5).
(Monograph was simultaneously published as Prevention in Human Services, Vol 7/2.)
The six papers which make up this book are all written by community practitioners in the
northern United States who work on various programmes aimed at prevention in the field
of mental health. Arguing for the necessity of addressing prevention issues, one of the
authors compares traditional mental health approaches (ie those with a curative focus only)
with "an ambulance service laboriously operating at the bottom of a cliff. People are
continuously falling from the top of the cliff above to receive triage and treatment below".
The bag of papers is mixed. There are two very different accounts of educational
programmes, one designed to increase the social competency of school children, the other
a series of workshops for divorcees. Three papers deal with the management of prevention
programmes, and one describes a "clearing house" approach to encourage the formation of
selfhelp groups.
How relevant are the ideas to a Third World context? Is prevention even auseful concept
here, or are we still 100 busy dealing with treatment? A primary emphasis on treatment
approaches is world wide. The editors point out that prevention programmes were popular
in the United States during the late 1960's and the 70's, but that functioning then became
comparatively difficult. Possibly for this reason most of the authors strongly advocate builtin
research and evaluation. Funders like to know that they are getting value for money.
The Ministry of Health in Zimbabwe does have a philosophical commitment to
prevention, but a situation of scarcity of resources means that, since prevention programmes
are usually low-profile, unless they can be shown to be cost effective they will not be
prioritised. Those who are committed to the concept of keeping the people from falling off
the cliff must therefore take seriously the necessity of proving effectiveness, and of
achieving the greatest possible effects with the least cost. This means we need as many ideas
as possible from anyone who has been involved in the same struggle elsewhere.
The quality of the articles is variable, and the reader's own interest areas will naturally
influence which seem important and which simply dull. Of least interest to me were two
long articles 'about the historical development of prevention programmes in particular
centres. My involvement in training made the two accounts of educational programmes
interesting, although the divorce workshops (one particularly) weredefmitely designed for
a specific rust world and middle class population, and could only 'travel' in modified form.
My greatest enthusiasm was for the paper presenting the clearing house approach to the
formation of selfhelp groups. These are valuable everywhere, but more so where resources
are scarce .. The issue of whether professionals empower or disempower such groups is
discussed, and the connection made with theprlncipleof member ownership of programmes.
All in all this collection of papers is not earthmoving, but there are some interesting ideas
in some of them.
Reviewed by Margaret Henning, Family Counselling Unit, Harare, Zimbabwe.