As the profound contribution of mental illness to disability, morbidity, and mortality has gained acceptance, mental health has grown into a global priority. One in five experience mental illness in their lifetime, and those who suffer are coming forward in unprecedented numbers. As more people seek care for themselves and others, providers are increasingly unable to meet the demand through existing systems and mental health care approaches.
In Managing Uncertainty in Mental Health Care, Drs. Patricia Rockman and José Silveira critically examine core assumptions informing the primary approaches currently used to assess mental illness in clinical settings, with an emphasis on clinician certainty. They illustrate how current diagnostic frameworks obscure clinician uncertainty while encouraging overconfidence and go on to consider potential strategies for lessening the impact of inevitable errors. Ultimately, this book makes a case for acknowledging the fallibility of clinical judgment, independent of competence and experience, and the need to modify approaches to mental health care so that they align with the irreducible uncertainty of the domain.
By exploring emerging transdiagnostic approaches to mental health care in terms of their alignment with irreducible uncertainty, Rockman and Silveira make space for error and offer clinicians a novel way to advance the fundamental aim of mental health care: to reduce the harm and suffering of all.
Table of Contents:
1. Uncertainty and the Incompatible Certainty Bias
2. The Brain as a Complex Adaptive System
3. Complexity in Clinical Practice
4. Limitations of Prioritizing Diagnosis
5. Diagnostic Errors in Practice
6. Confidence Versus Error
7. Mitigating Diagnostic Error Through Transdiagnostic Approaches
8. Priorities in Risk Assessment
9. Broadening Our View of Risk
10. A Novel Approach to Risk Identification
11. Uncertainty as Teacher: Education, Training, and Practice
Appendix 1. The Risk, Function, and Symptom Matrices
Appendix 2. Risk at a Glance
Appendix 3. Centre for Effective Practice-Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and Addictions-Related Risks and Functional Impairments
About the Authors:
José Silveira, MD, is a psychiatrist and Associate Professor in the Department of Psychiatry at the University of Toronto. Certified by the Royal College of Physicians and Surgeons of Canada in Psychiatry, Silveira serves as a diplomat of the American Board of Addiction Medicine. He is the Chief of the Department of Psychiatry and the Medical Director of the Mental Health and Addictions Program at St. Joseph's Health Care Center in Toronto. Silveira has extensive experience working across disciplines, including in Academic Health Science Centers and with the National Basketball Association's Player Assistance/Anti-Drug Program. He is the recipient of numerous awards and nominations and is regarded as a clinician, mentor, and ally of clinicians and patients alike.
Patricia Rockman, MD, is a psychotherapist and Associate Professor in the Department of Family and Community Medicine at the University of Toronto.