Why We Should Put Mental Health First

"If you had a billion dollars to make the world a better place, how would you spend it?" My answer is always the same. I would spend it on modern evidence-based psychological therapy for people with depression and crippling anxiety, and for children with disordered conduct. Why?

First, this is a truly massive problem which wrecks the lives of over one in 10 people worldwide. In rich countries, it is the biggest single cause of misery, accounting for more misery than physical illness does -- and much more than is caused by poverty or unemployment.

Second, it imposes huge costs on the rest of society. Among adults of working age, mental illness accounts for nearly as much sickness absence and welfare expenditure as are due to all physical illnesses put together. And among children, conduct disorder is the best predictor of a life of crime.

Fortunately, we now have really good tools to tackle the problem -- evidence-based treatments that will cure at least a half of all those treated and greatly reduce the rate of relapse. The treatments are based on the idea that thoughts influence feelings. The reverse is also true of course, but the best way into this vicious circle is by helping people to change their pattern of thinking. In cognitive behavioral therapy the patient learns to question his negative thoughts and to develop positive thoughts and plans of action. In mindfulness-based cognitive therapy the person also learns to control his attention and to observe tolerantly, as from outside, the progress of his unwanted thoughts and physical feelings.

These treatments are not expensive -- say, under $2,000 per course. Against their cost the insurer can set the savings on all the extra physical care which mentally ill people consume. The Treasury Department can also set the cost of reduced welfare benefits. On the best evidence both sets of savings are of the same order as the costs of the therapy. So we could extend these treatments to millions more people at no net cost to the rest of us.

Yet what do we actually do? We ration these treatments more heavily than we ration any treatment for physical illnesses of comparable severity. The result is that under a third of people with these problems are in any form of treatment -- compared with say 90 percent for diabetes. Of course, most people can get anti-depressants but these do not have such long-lasting effects, unless taken continuously. And many people do not want to take them. They want to be masters of their own minds. They want psychological therapy.

So it is time for more action on this issue. At present there is no effective lobby on behalf of mentally ill people -- and even less on behalf of non-drug treatments. By definition mentally ill people are unlikely to be vigorous advocates of their own cause. Relatives too are often reticent -- immersed in their own feelings of guilt. So a new constituency needs to develop -- including of course the psychology profession but also the millions of citizens whose thinking is increasingly influenced by evidence-based psychology.

Perhaps the largest single group are those who have been touched by spiritual disciplines emanating from Asia. At the last count 10 percent of Americans had used meditation -- the same as the proportion of British people who go to church each Sunday. The central feature of these disciplines is the training of your ability to focus your attention. In the Mindfulness-Based Stress Reduction (MBSR) course the focus of attention includes your own bodily state, your breathing, the pattern of your thoughts and your compassionate feelings for others. In one classic randomised experiment the people who took the course ended up both happier and with better antibodies. Equally important, such training can reduce the trainee's level of aggression.

We cannot easily foresee how our society will develop, but some things are highly likely. We shall become more psychologically conscious and more skilful at regulating our emotions. Feminine values will increasingly predominate and crime will continue to fall. In such a climate we should surely be able to give more priority to the attack on mental illness. Future generations will find it impossible to understand or excuse the current level of neglect.

Richard Layard is the Director of the Wellbeing Programme at the London School of Economics' Centre for Economic Performance, and author of the book Happiness - Lessons from a New Science.

This post is part of a series produced by The Huffington Post, the University of Wisconsin-Madison's Center for Investigating Healthy Minds and the Global Health Institute in conjunction with the Change your Mind, Change the World 2013 conference. This series of dialogues on global health, sustainable well-being and science & happiness will feature his Holiness, the Dalai Lama, and other thought leaders on May 15, and will be live Webcast on May 15 at 9:30am (CST) and 2pm (CST) via www.cmcw2013.com.