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A sobering assessment of the systematic failures of mental health work.

The United States is in the midst of a mental health crisis that cannot be ignored. Its effects are visible in overcrowded emergency rooms, homeless encampments, and frequent encounters between police and people with serious mental illness. And yet, our attempts to support people with mental illness—from medical care to housing support to basic hygiene—seem to never take meaningful hold despite the tireless work of professionals who attempt to help people bring together the pieces of a life. The problem is not in any individual effort though; it’s in the many ways these programs fail to work together. For those with serious mental illness, and those who work to ameliorate it, there is no system. There is only mess. 

In A Mad Mess, sociologist Owen Whooley uncovers the exasperating barriers, bureaucratic mismatches, and threadbare resources that have made a mess of what should be a supportive system. Set in Albuquerque, New Mexico—a city whose struggles echo those of communities nationwide—the book reveals the challenges mental health workers face daily, from tedious paperwork to occasional violence. Whooley follows workers across local outpatient service organizations, specialized police mental health units, and a psychiatric emergency department. Despite mostly good intentions and sometimes heroic efforts, he shows why this important work so often ends in failure. 

Written with deep sympathy and unflinching honesty, A Mad Mess reveals how the lack of a cohesive mental health system obstructs critical care and places roadblocks before front-line mental health workers at every turn. Most critically, for those who suffer from severe mental illness, these setbacks are a constant reminder that the institutions charged with helping them have left them on their own.

In contemporary China, people diagnosed with serious mental illnesses have long been placed under the guardianship of close relatives who decide on their hospitalization and treatment. Despite attempts at reforms to ensure patient rights, the 2013 Mental Health Law reinforced the family’s rights and responsibilities. In Between Families and Institutions, Zhiying Ma examines how ideological, institutional, and technological processes shape families’ complicated involvement in psychiatric care. Drawing on extensive ethnographic fieldwork in psychiatric hospitals, community mental health teams, social work centers, and family support groups as well as interviews with policymakers and activists, Ma maps the workings of what she calls “biopolitical paternalism”—a mode of governance that sees vulnerable individuals as sources of risk, frames risk management as the state’s paternalistic intervention, and shifts responsibilities for care and management onto families. Ma outlines the ethical tensions, intimate vulnerabilities in households, and health disparities across the population that biopolitical paternalism produces. By exploring these implications, Ma demonstrates the myriad ways biopower enables, inhibits, and transforms medical care in China.

The first major collection of outpatient data on the MMPI-2, the most widely used personality assessment test in the world. With the introduction of managed care to mental health treatment, patients increasingly are seen and treated in outpatient settings. Although the MMPI-2 and its predecessor, the MMPI, have long been used for outpatient assessment, the bulk of research on the test has been performed at inpatient psychiatric hospitals. This volume presents the first extensive set of correlates for the MMPI-2 in outpatient settings, demonstrating the relationship of MMPI-2 scores to clinically relevant behavior. Reporting the results of a large-scale research project on the use of the MMPI-2 in community mental health centers, this study provides clinically useful information concerning the interpretation of MMPI-2 scores and code types. Because the research found that the correlates in outpatient mental health settings are essentially the same as those in other settings, this book will be a standard reference for all clinicians who use the MMPI-2, regardless of where they work. "A well-written, well-organized presentation. The literature is extensively reviewed, both in terms of prototypic studies reporting MMPI interpretive correlates, as well as those performed by one or more of the authors using the MMPI-2. This comprehensive literature review and the knowledge base of the authors are quite laudable." Linda Nelson "This timely book presents extremely important data for the clinical and research communities. It is unusually comprehensive and thorough, representing what is probably the best effort to date at providing external correlates of MMPI-2 scales." David Berry John R. Graham, Yossef S. Ben-Porath, and John L. McNulty are in the Department of Psychology at Kent State University. Graham is professor and chair, Ben-Porath is associate professor, and McNulty is a postdoctoral fellow.

Ties that Enable is written for students, providers, and advocates seeking to understand how best to improve mental health care – be it for themselves, their loved ones, their clients, or for the wider community. The authors integrate their knowledge of mental health care as researchers, teachers, and advocates and rely on the experiences of people living with severe mental health problems to help understand the sources of community solidarity. Communities are the primary source of social solidarity, and given the diversity of communities, solutions to the problems faced by individuals living with severe mental health problems must start with community level initiatives. “Ties that Enable” examines the role of a faith-based community group in providing a sense of place and belonging as well as reinforcing a valued social identity. The authors argue that mental health reform efforts need to move beyond a focus on individual recovery to more complex understandings of the meaning of community care. In addition, mental health care needs to move from a medical model to a social model which sees the roots of mental illness and recovery as lying in society, not the individual. It is our society’s inability to provide inclusive supportive environments which restrict the ability of individuals to recover. This book provides insights into how communities and system level reforms can promote justice and the higher ideals we aspire to as a society.