09/20/2012 05:23 pm ET Updated Nov 20, 2012

You Need Help! : A Book Review by Lloyd I. Sederer, M.D.

Mark Komrad, M.D., had a radio show in the 1990s called Komrad on Call, a call-in program about mental health. He starts this book by telling us the single most common question he received was. "My relative [sister/brother/wife/child/parent/friend] is clearly experiencing some real emotional problems. I think she needs psychiatric help. How can I broach the subject?"

You Need Help is his answer to that question. Since it is one of the most vexing of questions for families and friends, it needs answering. Dr. Komrad describes his book as "a step-by-step plan to convince a loved one to get counseling" -- that is, how to convince someone to get help (treatment) for a mental (or addictive) disorder.

Much of the book readies the reader for his "how to" advice: There are chapters on getting involved, understanding mental health problems, and why mental illness goes untreated before he discusses what he regards the goal of help, namely, getting an evaluation. Then his chapters address tactics, such as time, place, and allies, and offer clear advice illustrated by many dialogues that exemplify his points. He appreciates that people with serious mental illness may not yield to persuasion, which has him discuss moving from "persuasion to coercion" and discussing "how to play hardball." Dr. Komrad writes that benevolence often underlies coercion, which he calls "compassionate paternalism," and he gives examples of its success. While he mentions the risks of coercion, I thought he underestimated them.

There is a very medical orientation to this book, which as a psychiatrist I suppose I should support, but I found it too narrow. Evaluations, very good ones, can and are routinely (and initially) done by well-trained mental health professionals who are not psychiatrists. In addition, primary care physicians, school psychologists and social workers, and clergy (among others) play critical roles in evaluation and treatment, more so than you would take from the page or two of text they receive. And treatment, especially for serious or persistent mental illnesses, is done by multidisciplinary teams, often working in community or hospital clinics, generally not in individual doctor's offices.

There are many roads to recovery (a term hardly noted in this book) from mental and addictive disorders. I wished that the readers had been given more information and clear support for a recovery orientation by Dr. Komrad, since it has come to dominate not just the world of addictions but the world of mental health as well. My surprise about the relative omission of recovery in this book was greater in that former first lady Rosalynn Carter (a champion for mental health and recovery since she chaired the first Presidential Commission on Mental Health in 1979) wrote the book's foreword. Medical psychiatry is still learning to harmonize with the recovery movement, and needs help to get there.

For readers in a hurry, the appendix "Seven Steps for Convincing a Loved One to Get Help" is a good coaching tool, and it summarizes the chapters that precede it.

Families and friends face extraordinary challenges helping a loved one enter and remain in mental health treatment. They also will face a bewildering mental health system and terribly uneven quality of care. They need information, support and coaching. Dr. Komrad's book can help.

Dr. Sederer's book for families who have a member with a mental illness, The Family Guide to Mental Health Care, will be published by WW Norton in the spring of 2013.

The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.

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