In the introduction the editors note that ‘community mental health care has evolved as a discipline for over 50 years now’. Thus, it seems wholly reasonable to produce a comprehensive textbook dealing with the ‘large diversity of perspectives’ on community care and embracing a wide range of authors, most of whom are based outside of the UK. In that sense this is a relatively international tome and benefits from this broad-church background, while being a little impractical in terms of what it can offer the general adult community psychiatrist in the National Health Service today. For example, there is a chapter on treatment pressures, coercion and compulsion, which is thoughtful but lacking any details of the Mental Health Act. The recent introduction of community treatment orders (which are not discussed at all) likewise indicates how quickly things change in the swirling pools of community treatment.

In terms of individual chapters and topics, the choice and structure is admirable. Chapters are relatively brief, well organised, have varying lengths of reference lists and cover most of the areas relevant to modern practice. Particularly strong is a section on service components, for example case management, in-patient treatment and crisis and emergency services, which are very much of the essence of the business. Other sections on stigma, policies and assessing the evidence for effectiveness likewise deal with areas in which a summary of the background situation is very valuable. In terms of the latter, the difficulties of measuring whether or not we are doing any good are well outlined, with particular mention of the ‘saboteur of setting’. Thus, we cannot discount the extent to which locality often outweighs any generalisability in terms of studies in a given community or a given programme.

Although the individual components of this textbook, by and large, are appropriate to the topic, there is no sense that this is anything more than a collection of reflective papers, summarising events and knowledge so far. It is not a call to arms, and while acknowledging the common barriers of stigma and discrimination, as well as funding, there does not seem to be a sense of purpose about why we should keep people out of hospital. The chapter on in-patient treatment is useful and insists that there will ‘always be a place for hospital care’, but there seems little real awareness of the way in which long-stay patients are building up in other (not officially in-patient) resources, for example in prisons. There is also, oddly enough, no reference whatsoever to the first book on community psychiatry principles – Community Psychiatry: The Principles – by Douglas H. Benett and Hugh L. Freeman in 1991. This may reflect a lack of historical appreciation or, perhaps, that modern fragmentations in community care are intrinsic to the recent vibe of modern short-termism in thinking (and reference lists).

In essence, this is a perfectly worthwhile contribution to our understandings of community psychiatry, and individual chapters do serve their purpose in terms of both trainees wishing to learn and consultants wishing to refresh. Whether there is any genuine specialisation required to understand community mental health is, however, a moot point, and there is little acknowledgement of the sheer physical, relationship and local practicalities of making sure that individuals with significant mental illness can be cared for outwith the confines of bricks and mortar. Somewhere in the background the asylums and their imprimatur do still linger, while mentally disordered offenders accumulate in prisons, hostels, so-called ‘hotels’ and the streets.