Review of David M. Clark and Richard Layard’s "Thrive: How Better Mental Healthcare Transforms Lives and Saves Money"

In advanced countries, mental illness is a leading cause of suffering. The World Health Organization’s 2008 study showed that mental illness accounted for approximately forty percent of all illness while stroke, cancer, heart disease, lung disease, and diabetes each accounted for less than twenty percent (p. 5). In spite of these startling statistics, advanced countries—like the United States—spend only five percent of their healthcare money on mental health, and this means that they spend only one percent of their total national income on this leading cause of suffering (pp. 88-89). Fortunately, Oxford Professor of Psychology David M. Clark and Richard Layard, a leading labor economist, have recognized this injustice and have written Thrive: How Better Mental Healthcare Transforms Lives and Saves Money not only to explain it to the public, but also to offer potentially effective solutions to it.

First, Clark and Layard focus on mental illness itself; then, they discuss current policies involving mental-health treatment and address the reasons why they are unjust; after, the two outline how this injustice affects people in advanced countries; and ultimately, they give readers evidence-based suggestions regarding what can be done to eliminate this injustice. While focusing on mental illness itself, Clark and Layard point out that although mental and physical pain are experienced in the exact same areas of the brain, and although mental illnesses like depression are—on average—fifty percent more disabling than physical conditions like angina, asthma, arthritis, and diabetes, three-quarters of patients who seek assistance from healthcare providers cannot get what they need (p. 55). They go on to say that this is because, in advanced countries like the United States, almost two-thirds of these providers cannot get outpatient services for people with mental illnesses. Meanwhile, they have half the number of problems finding help for people with physical disabilities and diseases (pp. 55-56). A mother once wrote to Layard:

“My daughter Charlotte suffers from depression associated with OCD, and she attempted suicide two weeks ago (it was a serious attempt). But she is still not in treatment despite being referred ten months ago. If she had a physical illness equivalent to this mental illness she is battling with, she would have been rushed to the hospital, and appropriate treatment would have been forthcoming” (p. 53).

Clark and Layard then address the reasons why so many providers cannot get outpatient services for people with mental illnesses and admit that the primary reason has to do with funders—who generally do not wish to provide the extra resources needed (p. 11). They do not wish to provide these extra resources, even though the social costs of mental illness are dreadfully high: In advanced countries like the United States, mental illness accounts for thirtyeight percent of the total amount of morbidity and twenty-three percent of the total burden of disease (p. 44), and this negatively impacts even those who are not—and whose family members and friends are not—suffering from mental illnesses by negatively impacting the economy through nonemployment, absenteeism, presenteeism (or working while mentally ill), and crime. Taking these four factors into consideration, this leading cause of suffering costs advanced countries nearly seven percent of their national income—and, again, the countries only dedicate one percent of their national income on combating this leading cause of suffering itself (p. 88). Finally, and most importantly, Clark and Layard outline what can be done to solve this problem, and they do so by referencing the United Kingdom’s Improving Access to Psychological Therapies Program, which the two helped start in late 2008. Using economic arguments, they and other founders of the program convinced their government to provide more funding to make evidence-based psychological therapies, like cognitive-behavioral therapy, more readily available to people who needed them. In the first six years, the program trained over six thousand therapists, and the therapists involved in it now treat around fifteen percent of people with anxiety and depression in England. By 2021, they hope to be treating at least twenty-five percent of Englanders with anxiety and depression (p. 198).

University of Pennsylvania Professor Aaron Beck was spot-on when he described Thrive as a “remarkable [book that] presents the issues in a style that is easy for the professional, the general public, and policymakers to understand.” Because Clark and Layard made the book both comprehensive and clear to even readers without a background in psychology, they help all readers understand that, to move forward, everyone must work to fight the injustice surrounding current mental-health policies. Everyone needs some training in mental health so that they understand that recovery from mental illness is possible. As more and more people understand this, more and more will be willing to organize and campaign for better mental-health treatment, as so many currently organize and campaign for better physical-health treatment.

Clark and Layard also explain to readers the importance of anti-stigma campaigns, and I believe that they could not be more accurate. Anyone who has struggled with or is struggling with mental illness should be as open about it as they possibly can be, because this not only helps raise awareness, but also encourages others struggling to reach out for help. Early on in Thrive, Clark and Layard illustrate how important this is by writing that, on average, the shame and guilt associated with stigma cause people with bipolar disorder to wait six years before seeking assistance; people with depression to wait eight; people with generalized anxiety disorder to wait nine; and people with social phobia to wait sixteen (p. 54). Given that the chronic stress associated with mental illness not only affects the mind, but also leads to the over-production of adrenaline, abnormal patterns of cortisol, poor immunity, and the over-adhesiveness of platelets—and, in turn, a shorter life expectancy—people with mental illness must not wait an extended period of time before reaching out for help. The time to reach out is now, so the time to speak out and combat stigma is also now.

-McKenna O’Sullivan