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Thrive: the power of evidence-based psychological therapies R. Layard & D. Clark London: Allen Lane, 2014. pp.384, £20.00 (hb). ISBN: 978-1-84614-605-3.

Published online by Cambridge University Press:  21 November 2014

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Abstract

Type
Book Review
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

This book takes an in-depth look at the grave injustice currently impacting on the lives of millions of people worldwide – the lack of availability of good quality treatment for mental ill health. At some point in our lives, one in three of us will be afflicted by mental ill health yet it is still largely a taboo subject, with many sufferers hiding their illness and those attempting to access treatment faced with many barriers to recovery. This book is written by an economist and a clinical psychologist from the perspective that mental ill health and the successful treatment of it is very much related to the economic prosperity of the country.

The book is divided into two parts with sub-sections within these parts. Part one begins by looking at the problem that currently exists in every healthcare system in the world; the very fact that mental health is as painful if not more debilitating than any physical counterpart, yet there is a real disparity between the treatment available for the two. This discrimination becomes even more unbelievable when you consider the amount of people suffering with mental illness, the effect untreated mental illness can have on complaints of physical illness and hence the cost to the state of subsidizing debility of those unable to work as a result of poor treatment and, in some cases, no treatment. The book then looks at the effect mental ill health can have on a person's life which includes: reducing life expectancy, affecting a person's ability to work, failed relationships, increase in physical problems and hence further visits to the GP. Mental illness can also affect people's educational achievement and hence earning power, the latter two being two of the most important success criteria valued in this country. In addition, mental health is the single biggest factor affecting the productivity of work places across the country, yet most do not have contingency/support plans available to employees afflicted by conditions that are more debilitating than physical illnesses such as diabetes, cancer, stroke and heart attack.

There is a real drive in the book to discuss the definition of happiness from an official perspective and from a human nature aspect. The authors describe in great detail how society in some ways is fundamentally flawed by the very fact that it neglects the importance of the inner being from an early age. The level of competition in the UK and countries alike is highlighted as being a major problem in society, with people aspiring to reach targets that have little relevance to their identity and inner well-being.

The second part of this book discusses the treatments currently available for mental ill-health, which include medication and scientifically proven talking therapies. As a service user I can confirm the two main treatments offered for mental illness are medication and CBT (Cognitive Behaviour Therapy), the most widely researched form of psychological treatment available that strives to help us change the cognitive thought processes that cause us most distress. Unfortunately, the former seems more readily available, and hence is a stop-gap treatment offered by countless GPs, who in most cases do not have the desired knowledge of specific conditions, nor the appropriate treatment available, which is a concern highlighted in detail throughout this book. At present, good quality CBT is proving much more difficult to obtain for many service users, but not all. The reason for these pockets of good quality CBT is the IAPT (Improving Access to Psychological Therapies), a “systematic way of organizing the delivery of evidence based psychological therapy within the National Health Service.” (p.193).

My own personal experience of IAPT has not been great and I currently reside in an area of the country where you cannot self-refer. However, it was encouraging to see statistical proof that recovery rates through the IAPT system are better than what people think and should give hope to sufferers that a better quality of life is possible. Having a clear model of how to implement an effective mental health service through the NHS is one thing but as the authors are aware, it requires all those involved, from the Government, to therapists, to GPs, to patients to be working together to deal with the very real existence of mental illness and the impact it has socially and economically on society.

In conclusion, the message is clear: mental illness is a very common and treatable condition (regardless of the form) that does not receive the same level of urgency in treatment terms as physical counterparts. Mental illnesses (such as stress/anxiety/depression) cause the greatest number of absences from the work place. The cost of not treating mental illness effectively places further demands on the economy in terms of loss of earnings, further problems with physical illness, and increased costs to the taxpayer in paying for incapacity benefits. IAPT is a relatively new service introduced by the author with a view to getting sufferers access to the treatments they deserve to improve quality of life. Although in its infancy, it has proven that people do recover and that scientifically proven psychological therapy such as CBT is, in most cases, highly successful, with patient progress being clearly measurable. Overall, I reckon this book would be a very useful resource for service users, to see the bigger picture and to give realistic hope and fight to those afflicted by mental illness.

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