My friend, Nina, sent me a message insisting I read a book that had just come out, Healing: Our Path From Mental Illness to Mental Health, by Dr. Thomas Insel. I get many book recommendations, and while I’m a voracious reader, I am picky with which “mental health” books I will read.
I found the introduction on Amazon, and within a minute, I was in tears heading to a full-on ugly cry in my kitchen.
I’m a woman that has struggled with mental health most of my life, a parent raising kids with their own mental health journeys, long-time professional that spent much of my career as an advocate and helping organizational, local, state & national entities renovate systems to be more grounded in data & evidence for a higher impact.
I read that introduction and, for the first time in my life, felt that someone had taken the time to publish what so many of us had been yelling from the rooftops for years.
I rarely get excited about books, but a minute later, I had purchased the entire book, and within a couple of hours, I had finished it. As I was reading, I briefly paused to text or email every person I had ever met in the field, demanding they stop everything and get this book.
I emailed national boards I sat on with people I barely knew because, as decision-makers, I needed them to read this book. In the scope of issues that have attention and momentum, mental health is at the bottom of the list, and this was the opportunity to help educate people on the crisis that is often ignored.
Dr. Thomas Insel
I took a few days before emailing Dr. Insel to thank him for his work. While some people get starstruck by Halle Berry or Harry Styles, I completely geek out over the trailblazers in my field.
So I did a quick Google search, and he has an impressive bio: Psychiatrist and neuroscientist, the former Director of the National Institute of Mental Health (NIMH), advisor on countless boards, founder of numerous mental health start-ups, but the one that spoke to me the most was that he’s also a parent of an adult child on their own mental health journey.
I have learned that “experts” may or may not have any lived experience with what they talk about, which for mental health, I personally appreciate when someone can remotely relate to my journey.
I sat down and non-meticulously crafted a fabulously rambling email about a million different reasons why I adored the book because so many of us become “experts” out of the experience because if not us, then who? I was shocked when he responded:
Thank you for such a moving and generous note. I wrote Healing for you and millions of others who had become “involuntary experts.” It means so much to know this message found the target.
He was right. Millions of people have become “involuntary experts” because our nation lacks a comprehensive, outcomes-based mental wellness system. As a result, we see the dire consequences in our prisons, homeless shelters, and the burnout of caregivers, to name a few.
Some Highlights for Me:
The chemistry of paint
You cannot appreciate the opening scene if you have never tried relentlessly to access high-quality care for yourself or your loved ones. During Q & A at a presentation as Director of NIMH, the first question was from an “agitated, tall, bearded man”:
“‘You really don’t get it,” he said. “My 23-year-old son has schizophrenia. He has been hospitalized five times, made three suicide attempts, and now he is homeless. Our house is on fire and you are talking about the chemistry of the paint.” As I stood there somewhat dumbstruck, he asked, “What are you doing to put out this fire?’”
I remember reading that, cheering out loud between tears, and rereading that same section repeatedly. It is what every person that has ever experienced the mental health system themselves or with a loved one has wanted to yell, but the hard part has always been… at who?
Who do you direct your anger and frustration at when the issues are systemic and are a revolving door of policy-makers, administrators, staff, and people some that have a clue, while many, especially policy-makers, have no background and instead listen to the lobbyists, corporations, and whatever political narratives have the most strength at the moment.
A trainwreck by any other name…
“If my son had been in distress from any other medical condition, a diabetic coma, or a cardiac collapse, would he have been sent home untreated from the emergency room?”
Mental health has always been the black sheep of the medical field, with such little research existing to understand the biology and causation of mental health to respond to and “treat” it adequately.
I remember attending a school mental health conference in Kansas City several years ago. The keynote at the time was an international psychiatry expert who elicited a collective gasp when he said, “Right now, evidence indicates that only 30% of our diagnoses are accurate at any given time, so we treat what we think and diagnose based on the impact of the meds.”
Whenever I see statistics on mental health, I take them with a grain of salt because it’s such a stigmatized field. Insel affirms that people don’t get help when they should, our data collection mechanisms are questionable at best, and insurance tends to drive treatment options. There is no other area of medicine that this would be acceptable.
Quality > quantity
“We have a sick-care system geared towards crisis, not a health care system driven towards recovery,” yet families (and those with mental illness) are relentlessly seeking the inconsistent and often non-existent high-quality care are being blamed for causing the problem when we don’t focus blame on families when someone is diagnosed with heart issues, diabetes, asthma, or any number of other non-mental health-related medical conditions.”
I remember several years ago when Eye Movement Desensitization and Reprocessing (EMDR) therapy, a specific method in which moving eyes in a certain way while processing traumatic memories provides healing, started to build momentum. But unfortunately, I began to quickly see many professionals advocating that EMDR was the ONLY treatment that worked, and that was the ONLY treatment they would provide.
Now I’m not advocating for or against EMDR, but I am firmly against recommending any provider that is a one-trick pony. It means that they are not individualizing a treatment plan using evidence-based practices effective for what the client is bringing to the table. Patient care is compromised if we try to use a one-size-fits-all model.
We have a shortage of care and a crisis in the quality of care. Now that decision-makers are paying more attention to mental health after Covid-19, there is a movement to put bodies into roles as mental health professionals quickly. But, unfortunately, we are seeing an increase in policies reducing the qualifications and training needed to work with patients as a hope that a beating heart alone will fix our problems.
Insel argues that we have a significantly underprepared mental health workforce trained to know when to use which treatments and which work, a gross lack of care coordination, and little accountability to measure outcomes. Without including these critical components of care, simply going to a therapist or a med-prescribing nurse practitioner alone isn’t enough.
Have the cake and eat it too.
“Outcomes are dire not because we don’t know what to do or we don’t have anything to offer, but because we fail to deliver on what we know or use what works.”
92% of business executives believe their productivity would improve if employees had better soft skills. These skills can help people learn to name, understand, regulate, problem-solve, communicate, cope, and live high-quality lives. An abundance of data, research, and evidence strongly supports that.
Research is clear that outcomes are better when we teach our children how to identify feelings because you cannot understand or regulate emotions if you cannot identify them.
One name for this is social-emotional learning, yet one of the most baffling things I continue to see is the false argument that social-emotional learning is “woke” and the cause of issues. So now there is legislation flying up across the country to ban social-emotional learning, the very skills business and industry are begging schools to teach.
For those of us that have been doing this for decades, to read and hear these arguments is disheartening because they only set us back.
Moreover, they undercut the reality of these fields and minimize the issues. Few people will take the time to research or question the accuracy of what they’re reading and sharing on social media.
Without engaging in higher levels of critical thought (another social-emotional learning skill) to better understand, we will continue this pattern of shooting ourselves in the foot.
Instead, the masses rely on decision-makers with little to no expertise to spend time and resources cherry-picking and arguing over terms they know little about rather than using that time and resources to build a sustainable mental health care system.
We cannot demand better outcomes yet create barriers to the evidence-based vehicles that will get us there. You cannot have your cake and eat it, too.
When we don’t use data, research & evidence, it should be no shock that we will continue to spin our wheels, only digging a deeper hole in the sand.
Follow the science
I completely geeked out over Chapter 6: Precision Medicine because he took a deep dive into the science of getting a better diagnosis for better treatment.
One of the most frustrating things for people struggling with mental health is that you quickly realize it’s all a guessing game because there is no blood test or a cheek swab that can give you an exact diagnosis.
I love that Insel argues, “If you build a diagnostic system based on symptoms, you are going to focus on treatments about symptom relief,” which many of us currently experience.
Throughout my career, I have consistently learned that mental illness and health were simplified to chemical production in the brain.
Dopamine & serotonin are good. Cortisol is bad. I admit my ignorance.
The biggest game changer for me was learning that we are talking about a circuit problem meaning the issues lie in the connectivity, or information flow, to and from different parts of the brain.
Through fascinating research, scientists are working on mapping the brain and are starting to identify specific patterns, or biotypes, for each brain disorder. So depression biotypes and connectivity issues differ from schizophrenia or other brain diagnostic labels. Mapping brain functioning is promising for future abilities to diagnose and treat patients more accurately.
Healing versus illness
“Mental health has become a measure of the soul of our nation.”
The driving point for this book is that we have to move from a culture and systems focused on the illness to a larger, more inclusive view of building sustainable wellness. It’s more than diagnosis and treatment and focuses on what Insel says may be the things we all need the most: people (connection), place (having a safe place to live), and purpose (finding your why).
His call for change acknowledges the complex intersectionality of disparity. Our focus on prevention, education, and eliminating inequities will take us from a system, culture, and world focused on illness to one flourishing in health.
Insel has masterfully written this book as a blueprint to get us there, too. Healing is a must-read for anyone but must be sent immediately to decision-makers, elected officials, administrators, leaders, trailblazers, parents/caregivers, and especially those that have ever felt shattered by the dysfunctional system.
Quotes With Thought Power:
- “For many with depression, hopelessness is a barrier to seeking care. For people with anxiety, avoidance is a core symptom.”
- “Families, long blamed unfairly as the source of the problem, are in fact critical for the solution, arguably more than in any other medical illness.”
- “We have at best a sick-care system geared to crisis, not a health care system designed for recovery.”
- “It is easier to get your kid into Harvard Medical School than to find a psychiatric bed in the state system.” Requoted from Dr. Ken Duckworth, acting commissioner of mental health and medical director for the Dept of Mental Health Massachusetts.
- “A 2016 survey found that in four states (Arizona, Iowa, Minnesota, & Vermont), fewer than five state hospital beds remainder per 100,000 people.”
- “The problem goes way beyond a lack of mental health treatment. That is absolutely a huge part of it, but it’s the tip of the iceberg. We have no social safety net in this country. Instead, we use police and the criminal justice system- especially in communities of color.”
- “The LA County and Chicago’s Cook County Jail are now the largest mental health care institutions in the nation.”
- “Between 1990 and 2005 a new prison opened in the US every 10 days.”
- “Better outcomes require improvements in quality of care as well as access to care. For the mental health crisis of care, quality is as much of a problem as quantity.”
- “Welcome to the world of mental health care, where what you get depends on whom you see.”
- “Most providers you see will do what they are comfortable with, whether this is what you need or not.”
- “These powerful treatments were limited to elegant, academic papers. No one was using these treatments for patients in the real world.”
- “Imagine managing hypertension without monitoring blood pressure or treating diabetes without measuring blood sugar.”
- “In the absence of measurement, confidence soon outpaces competence.”
- “Only 18% of psychiatrists and 11% of psychologists in the US routinely administer symptom rating scales to monitor improvement.”
- “In California, where some 20,000 people underwent sterilization, the practice was outlawed only in 2014.”
- “While these social media sites have increasingly become a haven for doomscrolling, privacy hacking, and toxic positivity, could they also be a gateway for care?”
Book: Healing: Our Path From Mental Illness to Mental Health
Author: Thomas Insel, MD
Author Background: Tom Insel, M.D., a psychiatrist and neuroscientist, has been a national leader in mental health research, policy, and technology. From 2002-2015, Dr. Insel served as Director of the National Institute of Mental Health (NIMH). More recently (2015 – 2017), he led the Mental Health Team at Verily (formerly Google Life Sciences) in South San Francisco, CA. In 2017, he co-founded Mindstrong Health, a Silicon Valley start-up building tools for people with serious mental illness. More info: https://www.thomasinselmd.com/about
Release Date: 2/22/22
Table of Contents:
Part 1: A Crisis of Care
Chapter 1: Our Problem
Chapter 2: Alien to Our Affections
Chapter 3: Treatments Work
Part 2: Overcoming the Barriers to Change
Chapter 4: Fixing Crisis Care
Chapter 5: Crossing the Quality Chasm
Chapter 6: Precision Medicine
Chapter 7: Beyond Stigma
Chapter 8: Recovery: People, Place, and Purpose
Part 3: The Way Forward
Chapter 9: Simpler Solutions
Chapter 10: Innovation
Chapter 11: Prevention
Chapter 12: Healing