Review: Thrive (Richard Layard, David Clark)
Mental illness reduces national income by about 4%, and yet we only spend about 13% of our health budget and about 5% of our medical research funds on tackling the problem.
As an economist who writes a fair bit on mental health, I regularly trot out statements like this about how costly mental health problems are to society and how the under-provision of services is grossly inefficient. To some the point may now seem obvious and trite. As evidence grows ever more compelling, government policy slowly shifts in response. One success story is the Improving Access to Psychological Therapies (IAPT) initiative, which has greatly improved the availability of evidence-based treatment for some of the most prevalent mental health problems in the UK. Yet in many cases we still await adequate action from the government and decision-makers. Two key players in getting IAPT into government policy were Richard Layard - an economist - and David Clark - a psychologist. In their new book Thrive: The Power of Evidence-Based Psychological Therapies, Layard and Clark demonstrate the need for wider provision of cost-effective mental health care in the UK.(Layard 2014)
The book starts with a gentle introduction to mental illness; what it is, who suffers, the nature of treatment. This will give any reader a way in, with an engaging set-up for what follows (though with one third of families including someone with a mental illness, most people will find the topic relatable). The opening chapters go on to dig deeper into these questions; do these people get help, how does it affect their lives and what are the societal impacts? These chapters serve as a crash course in mental health and though the style is conversational and easily followed, on reflection you’ll realise that you’ve absorbed a great deal of information about mental health. More importantly, you’ll have a deeper understanding. This isn’t simply because of the number of statistics that have been thrown at you, but because of the personal stories and illustrations that accompany the numbers. This forms the first half of the book - ‘The Problem’ - which encourages the reader to start questioning why more isn’t being done. Economists may at times balk at the broad brush strokes in considering the societal ‘costs’ of mental health problems, but the figures are nevertheless startling.
From there the book continues to build. In the second half - ‘What Can Be Done?’ - the authors go on to explain that actually there’s a ton of effective therapies available. We know what they are and who they work for, but they aren’t available. There’s no doubt that the view of the evidence presented is an optimistic one, but it isn’t designed to mislead; where evidence is lacking, the authors say so. The book seems to be written with the sceptical academic in mind; no sooner can you start to question a claim than you are thrown another baffling statistic to chew on. Various therapies are explored, though the focus is undeniably on depression and anxiety and on cognitive behavioural therapy (CBT). Readers with CBT bugbears may feel alienated by this, but should consider it within the broader scope of the book.
Readers would do well to stop after chapter 14. Things go sharply downhill from this point and could, for some readers, undermine what goes before. This would be a great shame. In all seriousness, chapters 15 and 16 would be better off read at a later date, once the rest of the book has been absorbed, understood and - possibly - acted upon. In the final chapters Layard and Clark make distinctly political proposals about how society should be organised. The happiness agenda takes centre stage. In places, mental illness is presented as simply the opposite of happiness. This is an unfortunate and unnecessary tangent. I have some sympathies with the happiness agenda, but for many I expect these chapters would ruin the book. The less said about them the better.
It is a scandal that so many people with mental health problems do not have access to the cost-effective treatments that exist. Layard and Clark demonstrate convincingly that the issue is of public interest. Thrive has the potential to instill in people the right amounts of sympathy, anger and understanding to bring about change. Many will disagree with their prescriptions, but this should not detract from the central message of the book.
Richard Layard, David Clark. Thrive: The Power of Evidence-Based Psychological Therapies. Penguin UK, 2014.