2015年经济学人 心理疾病治疗 身体与灵魂

Treating mental illness

Body and soul

A professional schism¹ hinders Britain's mental-health system

THE day after Mandy Peck tried to electrocute herself in the bath her family took her to a mental-health centre in Chelmsford and asked for help.

They were told that there were no beds available and sent home.

Two days later Ms Peck jumped to her death from a multi-storey car park. She left a daughter behind.

Ms Peck would not have been turned away had she arrived at hospital with a broken leg.

Yet the National Health Service (NHS) often fails those suffering from a broken spirit.

The numbers are fuzzy, but about one Briton in four suffers a mental-health problem at some time in their life,

ranging from mild anxiety to severe schizophrenia. Less than a third of those receive treatment.

That is in part because many sufferers are ashamed to seek help,

but it is also due to funding gaps and disorganisation within the NHS.

The result is a system in crisis, says Sue Bailey, a former president of the Royal College of Psychiatrists².

This failure is costly³. Mental-health problems cause more suffering in Britain than physical illness,

poverty or unemployment, according to Richard Layard, an economist⁴ and author of a book on happiness.

People with severe mental illnesses have higher rates of physical illness than the general public.

According to the King's Fund, a think-tank, this costs the NHS between ￡8 billion ($13 billion) and ￡13 billion each year.

Sufferers are also more likely to commit crime; mental illness has become the most common reason to claim disability benefits.

Researchers at the OECD, a club of rich countries, reckon getting mentally-ill people back to work could increase employment in Britain by nearly 5%.

Part of the problem is money. The consequences of mental illness cost the British economy over ￡100 billion a year,

according to the Centre for Mental Health, a think-tank, yet the NHS spends just ￡11.3 billion on the problem.

Some, like Mr Layard, see misplaced priorities.

Doctors spend about ￡3.5 billion a year treating the depression and anxiety disorders⁵ suffered by some 6m British adults—

a vast amount less than is spent treating the physical ailments⁶ of roughly 500,000 patients in the last year of their lives.

Recent cuts to health spending have fallen hardest on mental-health care, just as doctors say demand is rising.

The number of NHS beds for patients with mental illness has declined by over 30% since 2003.

Many facilities are now full. As a result patients are having to travel long distances or wait months for care.

To free up room, a mental-health centre in London has discharged patients to bed-and-breakfasts.

Others are not so lucky: sufferers picked up by police are often diagnosed in jail cells.

This week Norman Lamb, the minister for care, said that services for young people are “stuck in the dark ages”.

A second challenge arises from the way the NHS is structured.

Mental-health care is staffed and funded separately from physical care—treatment is focused on the mind or body, but rarely on both at once.

Yet research shows depressed⁷ people are more likely than others to develop heart and lung disease, and to suffer from strokes.

Mental illness also appears to make diseases more lethal⁸.

On average men with mental-health problems die 20 years earlier than those without them (most from causes other than suicide), says the British Medical Association.

The government is alive to these problems. Britain's spending on mental health may be inadequate⁹,

but it compares favourably¹⁰ with that of other rich countries.

From April ministers have promised to limit the long waiting times that prevent many people using mental-health services.

And in 2012 the government pledged to give mental health care equal priority to physical care,

enshrining this principle as part of the Health and Social Care Act.

But critics complain that the promise has yet to deliver much practical change.

Reform advocates would like better integration¹¹ between mental- and physical-health care.

“Liaison psychiatry” involves placing mental-health specialists in hospitals to work alongside doctors.

The Centre for Mental Health found that one such initiative in Birmingham reduced the length of hospital stays and the number of readmissions and improved the health and well-being¹² of patients.

The centre calculated that the programme saved four times its costs. Yet such services are often meagre.

It would be better and cheaper to keep sufferers out of hospital altogether,

says Emma Stanton, who runs Beacon¹³ UK, a mental-health consultancy.

Ms Stanton recommends treatment at home through teams of doctors, nurses and social workers.

Instead of swallowing antidepressants, health bosses would like sufferers of mild conditions to receive help under a programme called Improving Access to Psychological Therapies (IAPT),

which aims to expand the use of treatments such as cognitive¹⁴ behavioural therapy.

This helps individuals challenge the gloomy thinking that can lead to anxiety and depression.

The National Institute for Health and Care Excellence¹⁵ (NICE), which evaluates treatments, considers it good value.

Yet David Clark, an adviser¹⁶ for IAPT, says it reaches only a fraction of those who need it. He would like its budget doubled.

Convincing politicians to cough up more funds will be tough. Some critics fear that beefing up treatment of the most common mental-health problems risks saddling the system with overwhelming costs.

Fortunately there is a lot that can be achieved without more cash.

Many mental-health services still do not meet the standards recommended by NICE, and communication between services is poor.

Elaborate therapies are not always necessary—one effective treatment for those suffering mental illness is keeping them in a job.

Other types of therapy, say advocates, should pay for themselves by saving health-care costs and increasing productivity.

Improving Britons' mental health is not only humane¹⁷, but economical.

1 schism   

n.分派，派系，分裂

参考例句：

• The church seems to be on the brink of schism.教会似乎处于分裂的边缘。
• While some predict schism,others predict a good old fashioned compromise.在有些人预测分裂的同时，另一些人预测了有益的老式妥协。

2 psychiatrists   

n.精神病专家，精神病医生( psychiatrist的名词复数 )

参考例句：

• They are psychiatrists in good standing. 他们是合格的精神病医生。 来自辞典例句
• Some psychiatrists have patients who grow almost alarmed at how congenial they suddenly feel. 有些精神分析学家发现，他们的某些病人在突然感到惬意的时候几乎会兴奋起来。 来自名作英译部分

3 costly   

adj.昂贵的，价值高的，豪华的

参考例句：

• It must be very costly to keep up a house like this.维修这么一幢房子一定很昂贵。
• This dictionary is very useful,only it is a bit costly.这本词典很有用，左不过贵了些。

4 economist   

n.经济学家，经济专家，节俭的人

参考例句：

• He cast a professional economist's eyes on the problem.他以经济学行家的眼光审视这个问题。
• He's an economist who thinks he knows all the answers.他是个经济学家，自以为什么都懂。

5 disorders   

n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调

参考例句：

• Reports of anorexia and other eating disorders are on the increase. 据报告，厌食症和其他饮食方面的功能紊乱发生率正在不断增长。 来自《简明英汉词典》
• The announcement led to violent civil disorders. 这项宣布引起剧烈的骚乱。 来自《简明英汉词典》

6 ailments   

疾病（尤指慢性病），不适( ailment的名词复数 )

参考例句：

• His ailments include a mild heart attack and arthritis. 他患有轻度心脏病和关节炎。
• He hospitalizes patients for minor ailments. 他把只有小病的患者也送进医院。

7 depressed   

adj.沮丧的，抑郁的，不景气的，萧条的

参考例句：

• When he was depressed,he felt utterly divorced from reality.他心情沮丧时就感到完全脱离了现实。
• His mother was depressed by the sad news.这个坏消息使他的母亲意志消沉。

8 lethal   

adj.致死的；毁灭性的

参考例句：

• A hammer can be a lethal weapon.铁锤可以是致命的武器。
• She took a lethal amount of poison and died.她服了致命剂量的毒药死了。

9 inadequate   

adj.(for,to)不充足的，不适当的

参考例句：

• The supply is inadequate to meet the demand.供不应求。
• She was inadequate to the demands that were made on her.她还无力满足对她提出的各项要求。

10 favourably   

adv. 善意地，赞成地 =favorably

参考例句：

• The play has been favourably commented by the audience. 本剧得到了观众的好评。
• The open approach contrasts favourably with the exclusivity of some universities. 这种开放式的方法与一些大学的封闭排外形成了有利的对比。

11 integration   

n.一体化，联合，结合

参考例句：

• We are working to bring about closer political integration in the EU.我们正在努力实现欧盟內部更加紧密的政治一体化。
• This was the greatest event in the annals of European integration.这是欧洲统一史上最重大的事件。

12 well-being   

n.安康，安乐，幸福

参考例句：

• He always has the well-being of the masses at heart.他总是把群众的疾苦挂在心上。
• My concern for their well-being was misunderstood as interference.我关心他们的幸福，却被误解为多管闲事。

13 beacon   

n.烽火，（警告用的）闪火灯，灯塔

参考例句：

• The blink of beacon could be seen for miles.灯塔的光亮在数英里之外都能看见。
• The only light over the deep black sea was the blink shone from the beacon.黑黢黢的海面上唯一的光明就只有灯塔上闪现的亮光了。

14 cognitive   

adj.认知的，认识的，有感知的

参考例句：

• As children grow older,their cognitive processes become sharper.孩子们越长越大，他们的认知过程变得更为敏锐。
• The cognitive psychologist is like the tinker who wants to know how a clock works.认知心理学者倒很像一个需要通晓钟表如何运转的钟表修理匠。

15 excellence   

n.优秀，杰出，(pl.)优点，美德

参考例句：

• His art has reached a high degree of excellence.他的艺术已达到炉火纯青的地步。
• My performance is far below excellence.我的表演离优秀还差得远呢。

16 adviser   

n.劝告者，顾问

参考例句：

• They employed me as an adviser.他们聘请我当顾问。
• Our department has engaged a foreign teacher as phonetic adviser.我们系已经聘请了一位外籍老师作为语音顾问。

17 humane   

adj.人道的，富有同情心的

参考例句：

• Is it humane to kill animals for food?宰杀牲畜来吃合乎人道吗？
• Their aim is for a more just and humane society.他们的目标是建立一个更加公正、博爱的社会。