Better But Not Well: Mental Health Policy in the United States since 1950

by Richard G. Frank, Sherry A. Glied

The past half-century has been marked by major changes in the treatment of mental important advances in understanding mental illnesses, increases in spending on mental health care and support of people with mental illnesses, and the availability of new medications that are easier for the patient to tolerate. Although these changes have made things better for those who have mental illness, they are not quite enough. In Better But Not Well , Richard G. Frank and Sherry A. Glied examine the well-being of people with mental illness in the United States over the past fifty years, addressing issues such as economics, treatment, standards of living, rights, and stigma. Marshaling a range of new empirical evidence, they first argue that people with mental illness―severe and persistent disorders as well as less serious mental health conditions―are faring better today than in the past. Improvements have come about for unheralded and unexpected reasons. Rather than being a result of more effective mental health treatments, progress has come from the growth of private health insurance and of mainstream social programs―such as Medicaid, Supplemental Security Income, housing vouchers, and food stamps―and the development of new treatments that are easier for patients to tolerate and for physicians to manage. The authors remind us that, despite the progress that has been made, this disadvantaged group remains worse off than most others in society. The "mainstreaming" of persons with mental illness has left a policy void, where governmental institutions responsible for meeting the needs of mental health patients lack resources and programmatic authority. To fill this void, Frank and Glied suggest that institutional resources be applied systematically and routinely to examine and address how federal and state programs affect the well-being of people with mental illness.

Genres: Mental Health, Psychology, Nonfiction, Health Care

208 pages, Paperback

First published January 1, 2006

Reviews

[Sandy Amorado · Rating 3 out of 5]

This book gave some good insights on how mental health was/is viewed in our society and the improvements of treatments and discussions are lessening the stigma. Even though it was a quick read, it was very heavy to read. We still have a long way to go, but we are getting there.

[Dave · Rating 3 out of 5]

Excellent picture of how mental health changed over ~55 years. Interesting to read how incentives shaped choices in care and we had the happy accident of improving the lives of many of the mentally ill (largely indirectly through social safety net programs). The conclusion leaves something to be desired, though. I'd expect a better case if the solution moving forward is another federal coordinating office, especially if it's to report directly to the president.

I thought it was interesting that after demonstrating it was evidence-based treatment and safety nets that drove improvements in mental health over the past half-century (and not the purposeful objectives of government bodies), the authors would turn around and advocate for federal oversight as the next step.

While I'm skeptical of the solution the authors propose, the problem they identify is spot on. A rising tide driven by the welfare state has carried most patients up with it, but the highly specialized health needs of those with severe mental illness are likely to get inadequate care and slip through the cracks between multiple agencies. This is a problem that needs solving.

So I applaud the action of proposing a solution; I'm just not convinced yet.

[Max Murphy · Rating 3 out of 5]

Pretty good book. To the point, not filled with fluff as a lot of statistical/historical non-fiction is. The writers were to the point and stuck to facts- without making it cold or robotic. The book had just as much personal belief imbued into it as it did stats and numbers. It was a comprehensive look at mental health policy from 1950-2000. It's a bit of a bummer that this book is over a decade old, because some of the contemporary sections are so clearly outdated, and without a mention of Obamacare how can any healthcare policy discussion be complete?

However, it was a great historical analysis and a look at how the trends have been going. It will be frustrating to say the least to figure out if these trends have continued in the way they had been, but this was still a valuable read and one I'd recommend to academics in the field. A long look backwards is great for a long look forwards.

[Stephanie · Rating 4 out of 5]

This book is a huge contribution to the modern scholarship on the sociology of mental illness. Public policy on mental health is a massive part of our US health care system, yet it is rarely taught in universities in great detail. Anyone who wants to get a well-rounded, academically sound understanding of how our mental health system has changed in the last fifty years should read this book. It's a very accessible read, for both the scholar and the casual reader. I especially believe that people who have had some experience with the mental health system either on their own or through family or friends would find this a valuable read.