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Review of "Thrive"

By Richard Layard and David M. Clark
Princeton University Press, 2015
Review by Maura Pilotti, Ph.D. on Dec 29th 2015

Have you ever wanted to know if mental health care is a worthy endeavor for all parties involved? Besides ethical and psychological considerations, do economic analyses support the idea of devoting public funds to the treatment and perhaps prevention of mental illness? Often the debate on the potential beneficial effects of prevention and treatment of mental illness tends to focus on single individuals and revolve around the critical issue of whether interventions are evidence-based. Yet, health care policies may impact both the individuals who require services and the communities where these services are offered. Thus, how do potential benefits for single individuals translate into effects that are not only large-scale and long-term, but also both psychologically successful and economically sound?  In Thrive: How better mental health care transforms lives and saves money, Richard Layard and David M. Clark  analyze the economic costs and benefits of a public policy approach that equates the relevance of physical health and mental health needs. Their analyses lead to the conclusion that large-scale programs that make available effective mental illness treatments to consumers in need are economically viable, psychologically sound, and morally desirable. Most importantly, their analyses cleverly circumvent the often debated dilemma of whether health care is to be conceived as a right for all or a privilege that only a few can afford.     

The authors' narrative is informative, poignant, and accessible to a broad readership. The text is divided into two conceptually complementary sections: Part 1 is devoted to a description of the problem, whereas Part 2 is dedicated to available remedies. Across the entire text, scientific evidence is elegantly and concisely reported not only to explain its meaning, but also to emphasize its practical value. The authors skillfully combine a psychological viewpoint of mental suffering and its remedies with an economic viewpoint where treatment costs and benefits are pitted against those yielded by the lack of treatment. By doing so, they do not ignore structural and societal issues (e.g., poverty, lack of adequate education, unemployment, crime, physical illness and the shortage of adequate housing) that may be responsible for triggering and sustaining diverse forms of mental illness. Indeed, the authors acknowledge the utility of preventive policies and the necessity of social changes. Yet, they also recognize that interventions need to be considered for the people who are currently suffering from mental illness. Furthermore, they argue that mental illness, which may reflect both internal and external sources, is unlikely to disappear entirely even if structural and societal influences are addressed and salubrious alternatives are provided.

A well-developed review of the existing clinical literature leads Layard and Clark to highlight the desirable characteristics of cognitive behavioral therapy and its beneficial effects on a variety of mental disorders (e.g., depression and anxiety-based illnesses). Characteristics include the systematic structure of the treatment offered, its reliance on measurement to define the patient's condition and therapeutic success, and the availability of evidence of effectiveness provided by both traditional clinical studies and cutting-edge brain research. As such, it is expressly recommended for some disorders, such as mild, moderate, and severe depression, anxiety disorders, disorders of trauma and stress (e.g., post-traumatic stress disorder) and eating disorders. Of course, the term "cognitive behavioral therapy" refers to an umbrella under which one can find different specialized interventions that address qualitatively different problems, but conform to the same overriding theoretical principles. 

According to Layard and Clark, in spite of the number of individuals suffering from psychological disturbances in many countries around the world and the demonstrable effectiveness of specific psychological treatments (e.g., cognitive behavioral therapies), treatment is still unavailable to many. The authors share their experiences with "Improving Access to Psychological Therapies" (IAPT), which is a program that attempts to organize the delivery of treatment interventions by practitioners who are part of England's National Health Service. The program, which started in late 2008, makes available to localities teams of well-trained mental health practitioners whose interventions are supervised and measured. In doing so, it offers clearly defined guidelines for interventions and measurement, evidence of patients' progress and expected outcomes, and accessible information about therapists' required training and experience. Since the service is available to consumers without a general practitioner's referral and is performed close to where they reside, the program makes clinical treatments not only accountable and transparent to the public, but also available to those in need. Most importantly, its reliance on the supervised administration of required treatments allows quality control to be performed. In the book, the authors methodically examine evidence of the effectiveness of the IAPT and consider the criticism it has received since its inception. They conclude that albeit there is always room for improvement, it can be considered an effective model of mental health service delivery if its success rates are compared with those of existing service models.  

In sum, the authors' engaging writing style, selection of topics and content organization make Thrive: How better mental health care transforms lives and saves money a great read. The entire book or a targeted selection of chapters can be used as reading materials for a variety of higher education courses, from public health to abnormal psychology. For both broad and specialized readerships, the book can serve as a model for program evaluation based on the consideration and assessment of an array of factors, including psychological, social, ethical and economic benefits. It can also serve as an introduction to a mental health delivery program based on scientific principles, and thus reliant on measurable outcomes. Irrespective of the specific purpose that it may fulfill for each reader, the book is a must-read if one wants to appreciate current and past debates over health care policy.


© 2015 Maura Pilotti


Maura Pilotti, Ph.D., Ashford University