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A book review of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry by Lynn Nanos, L.I.C.S.W.

A book review of Breakdown: A Clinician's Experience in a Broken System of Emergency Psychiatry by Lynn Nanos, L.I.C.S.W.Stars: ****

Lynn Nanos (2018)
Mental Health Law/System
296 pages

Disclosure: I received a copy of this book in exchange for an honest review. This post contains affiliate links.

Summary: When hospitals release seriously mentally ill patients too soon without outpatient follow-up, the patients can end up homeless, jailed, harming others, or even dead. When patients are deemed suitable for inpatient care, they can languish for weeks in hospital emergency departments before placements become available. Meanwhile, patients who fake the need for care are smoothly and swiftly moved to inpatient settings. Breakdown opens a dialogue with anyone interested in improving the system of care for the seriously mentally ill population.

Using vignettes based on real interactions with patients, their families, police officers, and other mental health providers, Lynn Nanos shares her passion for helping this population. With more than twenty years of professional experience in the mental health field, her deep interest in helping people who don’t know how to request help is evident to readers. Breakdown uses objective and dramatic accounts from the psychiatric trenches to appeal for simple and common-sense solutions to reform our dysfunctional system. This book will benefit anyone interested in seeing a glimpse of the broken mental health system way beyond the classroom. It can guide legislative officials, family members, mental health professionals, and law enforcement officers toward a better understanding of the system.


This book is about the breakdown of the mental health system, specifically in the United States and even more specifically in Massachusetts. Even though I’m in Canada and our health system is quite different, I was curious to see what Lynn had to say.

She explains how the treatment of the mentally ill has changed from the 1800s through to now, specifically about the deinstitutionalization era which was meant to not have so many people fully institutionalized (a good idea) but ended up kicking out many seriously ill people who might need inpatient treatment. (bad outcome.)

There are many types of mental illness but this book focuses mostly on those with psychosis, especially those who don’t know they are psychotic. This includes Schizophrenia and some Bipolar with psychotic episodes. Borderline Personality Disorder is also talked about in one chapter, even though they aren’t psychotic. The point being made is that BPD is more severe than other personality disorders and perhaps shouldn’t be considered JUST a personality disorder.

A statement from page 129 shocked me at first but then when the author goes on to explain and give examples, I realized it was true:

“Mental Health Professionals discriminate against mentally ill people.”

It’s hard to accept that this might be the case. But I’m sure that the US isn’t the only place where this happens. Basically inpatient hospitals are saying they are full when really they don’t want the violent or difficult patients or ones who might need to stay long because a high turnover gives them more money. They also don’t want to take the patients who don’t realize their ill because they are difficult to convince to take treatment. The book explains this better.

I would really like a Canadian author to write a book on similar issues in Canada. I’m curious how much of it is the same. I know the insurance issues aren’t the same because of our universal health care but I know for a fact it’s still very hard to find an inpatient bed here and the system needs work. I know from personal experience and CMHA agrees with me.

Definitely worth a read if you are interested in how the mental health system in the US is failing, you are mentally ill in Massachusetts, your loved one suffers from psychosis or you work in the mental health profession.

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About Kathleen

I've been a nonfiction lover for as long as I can remember. I love children's nonfiction as well and love to share my knowledge and the books I gained them from, with the world. I wish more people would give nonfiction a chance.