Thrive: How Better Mental Health Care Transforms Lives and Saves Money

319 Pages·2014·8.07 MB·English

by  Richard Layard

THRIVE
THRIVE
How Better Mental Health Care
Transforms Lives and Saves Money
Richard Layard
and David M. Clark
Princeton University Press Princeton & Oxford
Copyright © 2014 by Richard Layard and David M. Clark
Original edition first published in the United Kingdom as
Thrive: The Power of Evidence-Based Psychological Therapies
by Penguin Books Ltd, London
Requests for permission to reproduce material from this work
should be sent to Permissions, Princeton University Press
Published in the United States by Princeton University Press,
41 William Street, Princeton, New Jersey 08540
press.princeton.edu
All Rights Reserved
ISBN 978-0-691-16963-7
Library of Congress Control Number: 2015936812
British Library Cataloging-in-Publication Data is available This book has been composed in Sabon
Next, Scala Sans, and Baucher Printed on acid-free paper. ∞
Printed in the United States of America 1 3 5 7 9 10 8 6 4 2
TO MOLLY AND ANKE
CONTENTS
Foreword by Daniel Kahneman ix
Preface xv
PART ONE: THE PROBLEM 1
1. What’s the Problem? 3
2. What Is Mental Illness? 17
3. How Many Suffer? 39
4. Do They Get Help? 53
5. How Does It Affect People’s Lives? 65
6. The Economic Cost 83
7. What Causes Mental Illness? 93
PART TWO: WHAT CAN BE DONE? 115
8. Does Therapy Work? 117
9. How Therapies Are Developed 133
10. What Works for Whom? 153
11. Can We Afford More Therapy? 181
12. Improving Access to Psychological Therapies 193
13. What Works for Young People? 219
14. Can We Prevent Mental Illness? 229
15. Would a Better Culture Help? 245
16. Stop This Pain 259

Our Thanks 267
Sources of Tables and Diagrams 271
List of Annexes 275
Notes 277
References 319
Index 367
FOREWORD
This book is an inspiring success story and a stirring call to further
action. Its message is as compelling as it is important: the social costs of
mental illness are terribly high, and the costs of effective treatments are
surprisingly low.
Some time ago, my colleagues and I set out to measure how much
suffering there is in our society. We conducted several studies in which a
large number of people provided a description of their day; they broke
their working hours into episodes, for each of which they specified the
starting time and ending time. For each episode they indicated the main
activity in which they had been engaged at that time, and they rated the
extent to which they had experienced various emotions. We classified as
“suffering” any episode in which at least one of the negative emotions
(for example, “depressed,” “worried,” or “angry”) was rated as more
intense than all the positive emotions in the list (for example, “happy,”
“enjoying myself”). We then computed for each individual the total
duration of bad episodes and the fraction of the day in which she had
suffered. We collected responses from many hundreds of women in
several countries (United States, France, and Denmark) and observed
that the average time spent suffering was between 15% and 20% of the
waking day. We also found that the distribution of suffering among
individuals was grossly unequal. About half the respondents indicated no
suffering at all. But the 10% who reported the most pain accounted for
nearly half the total suffering that we recorded in our sample.
The conclusion was stark: A significant minority of the population is
in almost constant psychological pain. A more positive conclusion was
that if we wish to reduce suffering in our society, we should concentrate
on alleviating the emotional (and physical) pain of the most afflicted
individuals. The sufferers at any one time include people who have
suffered a calamity of some kind—a painful divorce, the death of a