Emergencies in Mental Health Practice: Evaluation and Management

Emergencies in Mental Health Practice: Evaluation and Management

Kleespies PM, editor

New York, The Guilford Press; 1998. 450 pp

ISBN 1-57230-255-0 (cloth)

In the introduction to this book, the editor points out that most training sites for psychology interns provide limited or no training at all in emergency psychological services, reflecting a general inattention to such services in the field of professional psychology. However, the editor suggests, if clinicians are to regard themselves as independent practitioners, they must be prepared to assist patients in the event of a life-threatening behaviour or a psychological emergency, whether in the office, the emergency department or elsewhere. Referring to psychiatry as a paradigm, he recommends that mental health disciplines incorporate training in the management of emergencies as a professional requirement. For the purpose of such training, the editor offers the structure of this book as “a proposed curriculum for a knowledge base in emergency psychological services/’ The book is structured into 6 parts consisting of 19 chapters. Most of the chapters have been written from the perspective of the mental health professional who must evaluate and manage a behavioural emergency in the emergency department or, occasionally, in another setting. Some of these chapters are excellent, offering useful and practical advice. This is especially true of the chapters on emergency interviews, evaluation and management of suicidal patients and potentially violent patients, and emergency telephone calls. The 2 chapters on risk management offer helpful reminders of the importance of consultation and proper documentation in dealing with suicidal or violent patients. A laudable feature, not found in other comparable books, is the devotion of 3 chapters to the stressful impact on the clinician of patient suicidal behaviour, violent behaviour and disaster. The weaknesses of the book are likely the result of the large number of contributors — 33 in all — with 2 to 5 authors in 15 of the 19 chapters. There is duplication between chapters, the writing style is variable, and even the perspective from which the chapters are written differs. For instance, the last chapter is written from the point of view of the psychologist. The entire Part 5, consisting of nearly 100 pages, is not about emergencies but about syndrome psychiatry and pharmacotherapy, which are best covered in a traditional text-book. Inconsistencies also occur. A notable example is that considerable effort is expended in the first 2 chapters to distinguish “crisis” and “crisis intervention” from “psychological emergency” and “emergency intervention,” and to dissuade the reader from using these terms interchangeably. However, in chapters 3, 4 and 6, either these terms are used interchangeably or new definitions are given. Some chapters would benefit from increased succinctness and decreased preoccupation with referencing every statement.

The inspiration for this book came from the editor’s considerable clinical and supervisory work with psychology interns in emergencies at the Boston Veteran Affairs Medical Center. The editor and the chapters’ authors, most of whom are psychologists, have created a book that will serve well psychology interns, their supervisors, and students and staff of other mental health professions in the evaluation and management of emergencies in mental health practice. I hope that this book will be a catalyst for increased training in this important but rather neglected field of mental health practice.