In this admirable book, the authors make the case for what many readers of this journal have known for so long – that the inequalities between provision of care for physical and mental health problems are discriminatory, causing harm not only to the individuals concerned but also to the economy and society as a whole. Although the cloak of stigma is slowly being drawn aside with the help of enlightened politicians and the willingness of some prominent figures to be open about their own mental disorder, the evidence behind the arguments for improved services is still poorly understood by the general public, and - of significant concern - by many in positions of power including health commissioners.
Thrive is intended to be both an instrument of education and a campaigning tool. It challenges the underfunding of mental health services and shows why evidence-based psychological therapy is one of the best investments the next government could make. It contains well written, clearly laid out and easy to read personal stories. It is of value to both professional and layperson. The text is interspersed with graphics accessibly designed and not distracting. The data are central to every facet of the argument and are used both to scotch the myths surrounding mental disorder and to promote the economical and humanitarian cases for change.
So convinced are the authors by the strength of their arguments that they may on occasion lose the sympathy of a sceptical reader. Though the clinical and economic case is compelling, some decision makers may baulk at the upfront investment needed in order to achieve lesser costs and improved quality of life in the long run.
One priority area in my view, that is discussed by the authors, is developing psychological services in secondary care so that the patients who do not recover in IAPT are effectively “stepped up”. The delivery of psychological therapies is patchy in secondary care, often insufficiently evidence based and without evidence of outcomes. Delivering quality of care with the relevant outcome data is crucial for the government's agenda of referral to a consultant team of one's choice.
The book should be read by one's trainees and decision makers. It is important the argument should be pitched at decision makers constantly and from a variety of quarters. By distilling all the relevant information in a relatively brief and highly readable format, this book should help enormously. The authors invite readers to throw their copies at clinical commissioners – perhaps the BABCP should bulk buy Thrive and send wrapped with mistletoe to MPs and Healthcare Commissioners for Christmas.
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