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
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.
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