Better But Not Well – Frank, Glied, with Davis, Goldman and the Network

The forthcoming book, "Better But Not Well," has been a major undertaking by the Network. Drs. Richard Frank and Sherry Glied have led the Network in a comprehensive historical analysis of whether individuals with mental illness are better off now than they were 50 years ago. One of the book’s most important findings is that the mental health system has changed from a centralized system, dominated by state hospitals, to a loosely organized decentralized system. The shift has been driven largely by changes in financing that have led the once-socialized system, funded by state legislatures, to become a market system governed by the same policies affecting the American mainstream. Those policies include Medicaid, Medicare, subsidized housing, income supports, and criminal justice. People with mental illnesses are now found in many different service systems under the jurisdiction of a welter of state and federal agencies. Some systems are equipped to serve people with mental illness (e.g., Medicaid), while others are ill-equipped (e.g., the criminal justice system). The transformation has changed the meaning of the term “mental health system” and dramatically altered the way in which policy is implemented. The book concludes that the Nation’s mental health is better but not well. Individuals with a mental illness have better access to more effective care than they had in 1950. But there is a striking need to improve the quality of care and to increase resources available to them, regardless of the system in which they are found. "Better But Not Well" also helped the Network to identify a second generation of policy questions inspiring current Network projects.

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Last modified: June 1, 2006
©2006 MacArthur Foundation Network on Mental Health Policy Research
Last Revised: June 2006