There has been a sea change in the United States, for example, in the last 30-40 years in family integrity and support. The classical dyadic marital relationship for life has largely disappeared. In olden days, there used to a husband and a wife, wedded for most of adult life, and the resultant children, all full siblings. It has given way to what has been described as serial monogamy. In addition, there has been a large-scale increase in living together without marriage. Children can be full siblings, half-siblings and step-siblings. It is often difficult to keep track of them, even for the persons concerned. It creates major strains for children. “Your children and my children are beating our children.”

At the same time, the U.S. suffers from a continuing problem in providing for health care services, often hotly debated. About 15% of the total population does not have any health insurance and lacks the resources to meet health care costs. It is much higher for minorities and the poor. More importantly, as much as about 30% of the mentally ill lack it. As opposed to many other countries, the U.S. does not have a state-supported universal health care coverage. A major problem in outpatient services in mental health centres is to arrange medication for the patients.

Many third world countries are toying with the idea of private health insurance. The U.S. experience is a lesson for them, to be seriously considered.