First, all your comments on the weirdness of Western mental healthcare are probably better described as ‘the weirdness of the US healthcare system’ rather than anything to do with mental health specifically. Note they are mostly to do with insurance issues.
Second, I think one can always raise the question of whether it’s better to (A) improve the best of service/good X or (B) improve distribution of existing versions of X. This also isn’t specific to mental health: one might retort to donors to AMF that they should be funding improvements in (say) health treatment in general or malaria treatment in particular. There’s a saying I like which is “the future is here, it just isn’t very evenly distributed”—if you compare Space-X launching rockets which can land themselves vs people not having clean drinking water. There seems to be very little we can say from the armchair about whether (A) or (B) is the more cost-effective option for a given X. I suspect that if there were a really strong ‘pull’ for goods/services to be provided, then we would already have ‘solved’ world poverty, which makes me think distribution is weakly related to innovation.
Aside: I wonder if there is some concept of ‘trickle-down’ innovation at play, and whether this is relevant analogous to that of ‘trickle-down’ economics.
fwiw I don’t think most of this problem is due to insurance issues, though I agree that the US healthcare system is very weird and falls short in a lot of ways.
This also isn’t specific to mental health: one might retort to donors to AMF that they should be funding improvements in (say) health treatment in general or malaria treatment in particular.
I suspect that if there were a really strong ‘pull’ for goods/services to be provided, then we would already have ‘solved’ world poverty, which makes me think distribution is weakly related to innovation.
World poverty has been decreasing a lot since 1990 – some good charts here & here.
M-Pesa and the broad penetration of smartphones are examples of innovations that were quickly distributed. The path from innovation to distribution is probably harder for services.
A couple of quick replies.
First, all your comments on the weirdness of Western mental healthcare are probably better described as ‘the weirdness of the US healthcare system’ rather than anything to do with mental health specifically. Note they are mostly to do with insurance issues.
Second, I think one can always raise the question of whether it’s better to (A) improve the best of service/good X or (B) improve distribution of existing versions of X. This also isn’t specific to mental health: one might retort to donors to AMF that they should be funding improvements in (say) health treatment in general or malaria treatment in particular. There’s a saying I like which is “the future is here, it just isn’t very evenly distributed”—if you compare Space-X launching rockets which can land themselves vs people not having clean drinking water. There seems to be very little we can say from the armchair about whether (A) or (B) is the more cost-effective option for a given X. I suspect that if there were a really strong ‘pull’ for goods/services to be provided, then we would already have ‘solved’ world poverty, which makes me think distribution is weakly related to innovation.
Aside: I wonder if there is some concept of ‘trickle-down’ innovation at play, and whether this is relevant analogous to that of ‘trickle-down’ economics.
fwiw I don’t think most of this problem is due to insurance issues, though I agree that the US healthcare system is very weird and falls short in a lot of ways.
I don’t think this analogy holds up: we’ve eradicated malaria in many developed countries, but we haven’t figured out mental health to the same degree (e.g. 1 in 5 Americans have a mental illness).
World poverty has been decreasing a lot since 1990 – some good charts here & here.
M-Pesa and the broad penetration of smartphones are examples of innovations that were quickly distributed. The path from innovation to distribution is probably harder for services.