by Tom Pyle
Healing the Broken Mind: Transforming America’s Failed Mental Health System, by Timothy J. Kelly. New York University Press, 192 pages.
Everyone who encounter the public mental health system knows it. Even the President’s New Freedom Commission (2002), which assessed the public mental health system, declared it. America’s mental health delivery system is in shambles and needs dramatic reform. Of course this begs the question: how to reform it? The answer, unfortunately, has not been easy to find. Many in the field are good as diagnosing the system’s many problems. Few, however, have been good at prescribing a solution. Only work of David Mechanic and the fine book of Richard Frank and Sherry Glied (Better But Not Well) come to mind.
And then I found Tim Kelly’s 2009 book, Healing The Broken Mind: Transforming America’s Mental Health System. Formerly the commissioner of Virginia’s Department of Mental Health, and currently Director of Depree Center Public Policy Institute at the Fuller Theological Seminary, Kelly offers us a refreshingly simple, succinct (under 200 pages !), and sensible prescription. Transforming the system requires attention to five critical considerations:
- Adequately funded
- Committed to change
In other words, mental health systems must be results oriented, derived from evidence-based outcomes measurement. They must also be open to competition, since the current monopolistic approach of state governments stifles service delivery. Of course they must be adequately funded, although not only by means of increased funding, but by better use of current funding. (This is especially important in Medicaid-funded mental health, which the Kaiser Commission estimates wastes at least 20% of all expenditures.) Mental health services must also be consumer-driven, meaning engaging and satisfying the subjects of treatment and rehabilitation, namely those with the psychiatric disabilities who for too long have been marginalized by the imperially oriented medical-model system. Finally, they must be committed to change to overcome the stultifying inertia of the status quo. If we can implement improvements together in these five areas, Kelly is confident that the system can experience dramatic transformation.
Kelly’s blueprint is a very important contribution to the field of health services leadership. It is pithy enough to read quickly. It is clear enough to digest easily. It belongs on the bookshelf—and in the forefront of thinking—of all mental health policy makers and advocates. It deserves immediate implementation so to transform once and for all our mental health care system, now considered a disgrace to one that shines with distinction. Our afflicted brothers and sisters, and their families, deserve no less.