Economics and mental health care

Jacob, a loyal MR reader, writes to me:

I am a research assistant involved in an evaluation of the quality of mental health care.  It turns out that much of “quality” from a clinician's perspective involves coercing/convincing/luring patients into treatment – patients should show up quickly (“initiation”) and repeatedly (“engagement”) and for a really long time (“continuation-phase treatment”).  For example, health plans are graded on the proportion of depressed patients that they can keep on antidepressants for 6 months (link – pg 23).  

So, how do you think about markets and individual-level-decision making among the severely mentally ill. On one hand, it feels inadequate to throw up ones hands and say everyone is the best ruler of themselves.  But it also feels inadequate to defer fully to the experts.  I’m sure this topic has been tackled elsewhere but a thoughtful analysis has evaded me so far.

A few points:

1. Here are some recent reported results about conceptualizing mental illness; I cannot vouch for them.

2. Here is an article about the fracturing of the concept of mental illness.  Here is The Economist on the same topic.

3. The mentally ill have it tough in China.

4. Here is one story of rational economic man.

5. I disagree with Bryan Caplan's argument that mental illness is a false category; he is making an odd turn toward behaviorism.  That the behavior can be reduced to preferences and constraints does not mean that is the best or only way of understanding the phenomenon (which is not just about behavior).

6. Here is the major paper on economics and mental health.  Here is a collection on the same topic, by the same authors.

7. You won't find the answers to your questions in any of those places, or here.  I do, in the meantime, hold two views.  First, historically the concept has been used — indeed abused — to incorrectly rationalize a lot of forcible institutionalization.  Second, it is not a meaningless concept, though fractured it may be.