Joining the chorus of voices in the health care debate, an issue that has continued to dominate the American conversation, is Timothy A. Kelly with Healing the Broken Mind. As Director of the Dupree Center Public Policy Institute, an Associate Professor of Psychology at the Fuller Graduate School of Psychology, and a licensed clinical psychologist himself, Kelly is certainly qualified to turn the spotlight on mental health care, and provide a measured criticism of the current system to treat the mentally ill. Simultaneously, he provides a multifaceted, pragmatic approach for introducing improvements. Simple, direct, and borne from common sense, Healing the Broken Mind may not contribute anything new to the mental health care debate, but it summarizes existing strains of thought with uncommon clarity. This book is most valuable to the general reader, looking for a bird’s-eye overview of mental health care challenges and possible solutions.
Starting with the premise that America’s mental health care system is fundamentally broken, Kelly retreats into a more conservative position as he outlines his recommendations, offering incremental reform rather than a call for revolution. These recommendations involve five key strategies: implementing evidence-based treatment, in which success is measured by scientifically-measured results and the lessening of symptoms; breaking the government monopoly of the health care system in favor of private competition; introducing parity, so that mental illness is insured in the same way as physical illness; giving more authority to the patient and his or her family in deciding the course of treatment; and convincing everyone involved in the system to adopt the previous four measures and to abandon the status quo. As Kelly characterizes it, the current system features little accountability, the lethargy of noncompetition, and the stigma of being segregated from other health services. The status quo also involves little emphasis on goals or results: for example, a mental health clinic might only keep track of the number of pills administered, instead of trying to quantify the success of those pills’ ability to actually eliminate symptoms. Keeping his arguments as apolitical and non-partisan as possible, Kelly refuses to ascribe blame to any one entity in the mental health bureaucracy, looking at the various issues from multiple perspectives. While some readers will appreciate Kelly’s refusal to enter the political fray or take sides, others, especially political partisans, might find his approach rather milquetoast or even toothless.
Regardless, Kelly is eminently qualified to state his case. He was appointed Commissioner of the Virginia Department of Mental Health in the late 1990s and has also served on several boards, and commissions assembled to examine the state of mental health care. His assertions are well-researched—he cites paper after paper—and written in a decidedly accessible manner to which the non-professional will respond, especially since he provides definitions of both simple terms and jargon and otherwise employs very basic vocabulary. There is also a distinct scarcity of data and statistics, a lack that might endear a lay reader but repulse professionals or those hoping to find Kelly’s arguments bolstered with numbers. In a welcome touch, Kelly also humanizes the policy discussion with fictionalized case studies of people suffering from mental illness and how they are being dis-served by the current system.
Kelly ends on a note of hope and optimism, believing that America stands “at the edge of history” and that a “perfect storm,” which will usher in a new era in healthcare, is on the near horizon. This concurrence of circumstances consists of three factors: visionary leadership, economic imperative, and public outcry. As with his recommendations, Kelly’s rosy view of the future is both admirably and frustratingly apolitical. In the author’s attempts to transcend politics and avoid igniting partisan bickering, it is up to the reader to decide whether Kelly has provided a realistic roadmap or just a pie in the sky vision.
Setting aside the effectiveness of the discourse, Healing the Broken Mind is worthwhile simply because it opens a window into the sometimes grossly incompetent mental health bureaucracy. Kelly provides a brief history of treating mental illness, and while the author admits that America has come far from the asylums of the 19th century, he also exposes the reader to the current system’s wasteful spending, inherent inertia, and stubborn refusal to concern itself with whether treatments are even working. Some of Kelly’s ideas seem so commonsensical that the reader can only groan in dismay that they aren’t already standard practice. The story Kelly unravels is a story of the worst kind of government mismanagement, a story of insurers, providers, and policy wonks too invested in the largess and easy comforts of “business as usual” to bother changing things for the better. Government bureaucracy is usually a pejorative term, and Healing the Broken Mind demonstrates again and again how well-deserved this sentiment is.