Thrive: How Better Mental Health Care Transforms Lives and Saves Money Hardcover – September 15, 2015

It is a good book and book condition is excellent

Layard and Clark's book is a UK-centered synthesis of mental health policies. It blends the economics of disability and social insurance with recent empirical findings on therapy effectiveness. The book takes a social cost-benefit perspective to mental health policies, arguing that direct public expenditures on effective treatments more than compensates by returning patients to an active role in the economy. A good mental health policy pays for itself."A significant minority of the population is in almost constant psychological pain" writes Daniel Kahneman in the foreword of the book, which presents a conundrum for the healthcare sector: "While nearly everyone who is physically ill gets treatment, two in three of those who are mentally ill do not." (p. 3). This bias is even more striking when the WHO estimates that up to 19% of adults face a mental illness in their lifetime, and that the costs of mental health have been extraordinarily underestimated: Layard and Clark compellingly show how these problems can reduce life expectancy as much as smoking, account for half of all work disability, and account for educational outcomes in children as much as IQ can. "Mental ill health explains more of the misery in the population than physical illness does" (p. 66), and this is without counting channels like domestic violence and other forms of crime.Stigma, relational guilt, a lag in recognizing the effectiveness of some treatments (particularly replicable randomized control trials on CBT - cognitive behavioral therapy), have left many people in an unfair limbo: to fend for themselves precisely at a time when they are less capable of doing so. The evidence for CBT is quite impressive for a large array of ailments like depression, anxiety, and even schizophrenia, as "50% of people treated with CBT for depression or anxiety conditions recover during treatment, and many others improve significantly." (p. 8). For anxiety, "Randomized controlled trials have established that CBT is effective in the short term, with 60– 80% of individuals becoming panic free." (p. 161). Moreover, CBT costs, despite variability and based on data for the UK, an average of $2.000 and provide effective results within just a couple of months.The book is very UK centered, and its conclusions don't necessarily carry over to other healthcare systems, especially those with high costs, atomized insurance, or institutions that cannot exclude treatments based on lack of supporting evidence. A very important point, hidden in the middle of the book, is that implementing a mental health policy most likely involves huge treatment heterogeneity because therapies, like CBT, are not easy to standardize. This is an important lesson from the roll out of the UK's Improving Access to Psychological Therapies (IAPT) program, and it should have been discussed further. In issues such as this one the book seems unbalanced, too close to advocacy, perhaps overselling the upsides of a mental health policy.Nevertheless, few policies have such reliable clinical evidence and cost-effectiveness support. Layard and Clark conclude that "evidence-based treatment should be as available for mental as for physical illness" (p. 260). Hard to disagree with that.

Very few of us can, if we are honest, say that we have never, ever suffered from some form of mental illness at one time or another, or that we won’t in the future. It may just be a matter of degree. Statistics, despite being shocking, probably don’t tell the true picture: over 20 per cent of people in developed countries suffer from a mental illness – the leading cause of suffering – which reduces life expectancy as much as smoking does and is responsible for a tremendous amount of sickness and disability claims.So anything we can do, as a society, to reduce the problems mental illness can create and improve the conditions for those who suffer from it, the better it will be. A win-win if you will. The authors believe that wide-ranging, fresh policy changes and a perception shift over mental illnesses can yield benefits, noting that many new therapies can be highly effective and pay for themselves in the longer term.“Mental pain is as real as physical pain. It is experienced in the same areas of the brain as physical pain and is often more disabling. Yet these two types of pain are not treated equally. While nearly everyone who is physically ill gets treatment, two in three of those who are mentally ill do not. If your bone is broken you are treated automatically, but if your spirit is broken you are not. This is a shocking form of discrimination, which occurs in every health care system in the world. It is particularly shocking because we have very good treatments for the most common mental health problems, which are depression and crippling anxiety disorders. The treatments – modern psychological therapy and drugs when appropriate – are not expensive,” wrote the authors, who obviously focus on the more acute levels of mental illness. There are many others who suffer mental illnesses such as stress, mild depression, burnout and bullying who also need help but are often side-lined.The book itself is interesting, even to a general “concerned citizen”. It is not something written for psychologists or politicians. It uses clear, decisive and open words to describe a rather large problem and offers some considerate thoughts as to how the problem can be reduced, mitigated or managed.We should not need a book like this. Sadly we do. As long as mental illness is either hidden away in the shadows, partially out of shame and partially due to the “unpleasantness” of it all, we cannot go forward. By treating successfully even a proportion of those who are suffering, as a society we would be making the everyday lives of many so much different and they would be able to contribute back to society a lot more than their “costs” thus far.Maybe this book will encourage slowly a change in how we think about mental illness. For all those who suffer, often in silence, one hopes so.

Eye opening insights, and a must-read for mental health professionals.