Out of the mainstream

Rosemary Loshak, London and New York, Routledge, 2013, 205 pp, RRP £24.99 (paperback), ISBN 978-0-415-68270-1

This book makes a significant contribution to the endeavour to help children whose parents suffer from mental illness. The editor is a psychoanalytic psychotherapist and social worker who has been at the forefront of developing a pioneering service for these children and their parents. Chapters written by professionals working from different perspectives present a picture of the development of a community service called the Children and Adult Mental Health Project (CHAMP). The book depicts the struggle to knit together different agencies in the common task of focussing on the needs of children whose difficulties have historically been difficult to address. The tendency is always to focus on the individual patient rather than the patient and their context, and the child's needs are often eclipsed by the apparently more acute needs of the parent(s) with a mental illness. The struggle to work across organisational boundaries is usefully complemented by the inclusion in the book of different theoretical perspectives but at the heart of the book is psychoanalytic thinking, whether applied to organisational issues or to clinical situations.

The authors of different chapters repeatedly comment that there is a huge unmet need for services. Research is quoted showing that one-third of the children of mentally ill parents are unaffected, one-third develop some difficulties and the remaining third suffer from very significant difficulties. In the UK, two million children are living with a parent or parents with mental illness. In the area where the service described was set up, Tower Hamlets in East London, the community mental health teams were working with approximately 500 adults of whom one-third were parents. The book contains vivid descriptions of the need voiced by children to be taken account of by the services concerned with the mental health of their parents. I