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Better But Not Well

, 208 pages

13 b&w illus.

April 2008



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Better But Not Well

Mental Health Policy in the United States since 1950

The past half-century has been marked by major changes in the treatment of mental illness: 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.

Richard G. Frank is the Morris Professor of Health Economics at Harvard University Medical School and a research associate at the National Bureau of Economic Research. Sherry A. Glied is a professor in and chair of the Department of Health Policy and Management at the Mailman School of Public Health, Columbia University.

"Offers many insights beneficial to the informed reader."

"The authors are true to their word in providing an excellent overview of changes in the last 50 years. They provide compelling evidence that the condition of many, if not most, persons with mental illness has improved during that period."

"By pulling information from a wide variety of sources, these authors provide a fresh and optimistic look on improvements in the well-being of people with mental illness. A major contribution to the field."

"An important and provocative addition to the literature dealing with health policy."

"Professors Frank and Glied offer a broad-based and candid assessment of the evolution of mental health care in the United States and of how the well-being of people touched by mental health problems changed during the last half of the twentieth century."

"Will be of greatest interest to students of mental health economics, services, and policy, but clinicians interested in the relationship between health policy and everyday practice will also find it useful."

"Provides a necessary counterpart to much overenthusiastic optimism surrounding recent development in psychopharmacology and the neurosciences."

"Offers a fascinating... historical analysis of mental health policy."

"Should be assigned to every practitioner, mental health clinician, administrator, and advocate — as well as every legislator and policy maker—concerned with the status of Americans with serious mental illness."

"If one... has time to read one book on mental health policy this year, this should be the one."

"A comprehensive assessment of changes in the life conditions and well-being of persons with serious mental illnesses over the past five decades."

"A well-written and important work that provides a definitive look at the past and a glimpse into the future of mental health policy in America."

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