Thomas Insel psychiatrist and expert in public health, talks about how mental illness is a medical issue that needs social solutions.
At the heart of the way we talk about mental health in America is a paradox. On the one hand, we have gotten better and better at treating mental illness over the past few decades. Psychopharmaceuticals have come a long way, and there are now new, more effective ways to do psychotherapy. We also know more about what kinds of social support are best for people going through mental health crises.
But at the same time, things have gone in the wrong direction for mental health. About once every 11 minutes, someone commits suicide in the United States, and about half of those who do so have not gotten mental health care. In the past few years, the number of young people with anxiety, depression, and eating disorders has gone through the roof. From 2009 to 2015, the number of girls ages 10 to 14 who went to the emergency room because they hurt themselves more than doubled.
Thomas Insel knows better than anyone how this disconnect works. He is a psychiatrist and researcher who was in charge of the National Institute of Mental Health for 13 years. He has also worked with California’s governor, Gavin Newsom, as a special adviser on mental health care. But in his new book, “Healing: Our Path from Mental Illness to Mental Health,” he says that the mental health community’s “herculean efforts” have not been enough. The book talks about how bad our mental health care is and what more we could do with what we already know and what we’ve found. “To put it simply, the mental health problem is a medical one,” he writes. “But the solutions are not just medical; they are also social, environmental, and political.”
In this conversation, we talk about why our current medical system is so bad at helping people with all kinds of mental illnesses, why psychiatric research and patient outcomes are so far out of sync, how the U.S. government got out of mental health care in a systematic way in the 1980s, and how that created a fragmented system of care. We also talk about why it’s so hard to find the right therapist, what treatments we know work really well and why we often don’t use them, why mental health is not just a medical problem but also an economic and social one, what public policy can and can’t do to solve our mental health crisis, the link between loneliness and mental illness, how the weakening of family and social ties is affecting our mental health as a whole, and more.