Abstract
After President Obama’s attempts to get insurance cover for nearly 30 million Americans who had none, healthcare matters continued to dominate the US political agenda, as they did in the UK during the general election. Mental health issues are never attractive to society, although this is beginning to change as was evident from recent campaigning in the UK election. With an increasing number of celebrities declaring openly their experiences of depression, post-natal depression and addictions of various kinds, at least a platform is becoming available for public discussion. Looking at the Leader of the Free World from across the pond, what is stunning is that there are some centres of excellence in the delivery of mental healthcare in the US with well-resourced training centres but there are also vast swathes of wasteland in healthcare delivery. The relationship between providers and consumers is really one-sided even in the capitalist world.
In this book, Kelly, who trained as a clinical psychologist and was commissioner of Virginia’s Department of Mental Health, Retardation and Substance Abuse, writes about the broken mental healthcare system in the US using sharp insight from within, picking problems, identifying obstacles and putting forward suggestions to mend the broken system. There are harrowing instances and case reports where individuals are not aware of the insurance limitations for treatment for addictions or severe mental illness, resulting in huge financial and emotional cost to individuals and their families. What is intriguing is that politicians and stakeholders are not prepared to pick up the message that patients can become productive members of society and add to economic growth through work and taxes, which would result in lowering the burden of disease. Perhaps that reflects short-term political vision.
In this volume, Kelly lays bare the underbelly of the mental healthcare system in America with surgical precision, highlighting a sense of frustration and surprise that this should be so. From his unannounced visits to various facilities and seeing staff in (in)action, he attempts to change the system. One of the major messages is that patients and carers must be partners in treatment and service development. Kelly asserts that measurement of outcomes is crucial. It is interesting that he places Australia as the leader in using Health of the National Outcomes (HONOS) data, which was developed in the UK.
This book, a challenge both for the profession and for policy makers, is an eye-opener. It should be compulsory reading for policy makers, and professionals must clean up their act.