Healing

Hello, I hope you had a wonderful holiday with friends and family!  Evelyn and I ate too much. 
 
The holidays are a joyous time but also a difficult time for many Americans.  How do we make people happier and more mentally healthy?  That’s the subject of Thomas Insel’s book “Healing: Our Path From Mental Illness to Mental Health.”  Tom would know as the former director of the National Institute of Mental Health, a billion-dollar federal agency that funds mental health research.  Tom is also an advisor to the Good Life Movement, a public movement of action for mental health. 

Tom’s book is born of hard-won experience.  He recalls speaking to an audience about mental health research when an impassioned parent said, “You really don’t get it.  My 23-year old son has schizophrenia.  He has been hospitalized five times . . . and now he is homeless.  Our house is on fire and you are talking about the chemistry of the paint.”  Tom does get it.  His son had struggles with ADHD and his daughter with anorexia.  There is now broad acknowledgment that America has a mental health crisis on its hands, whether it’s anxiety and depression or deaths of despair.  Indeed, according to Tom 60% of mental illness goes untreated.
 
“Our current approach is a disaster on many fronts.  Not only is mental health care delivered ineffectively, but it is mostly accessed during a crisis and strategically focused only on relieving symptoms and not on helping people recover,” Tom writes. 
 
Tom discusses the closing of 95% of public hospital beds for the mentally ill coupled with the dramatic increase of prisons over the last 50 years.  As he puts it painfully, “America has invested in incarceration instead of rehabilitation” to the point that “hospitals have become prisons and prisons have become hospitals.”
 
So what works?  One thing with demonstrated effectiveness is Coordinated Specialty Care, which is when family education and support, case management, psychotherapy, medication management and work or education support are all coordinated together when someone has their first psychotic episode.  Too often, different parts of someone’s life don’t talk to each other, particularly if people stigmatize treatment. 
 
Tom sees a role for technology, but “technology will not and cannot replace boots on the ground.  We will need clinical experts, we will need hospitals and crisis teams, and we will need people who can listen when someone has turned off their phone or unplugged from social media . . .[we need] both high tech and high touch.” 
 
Tom diagnoses the failures of the marketplace – that we have a ‘sick-care’ system not a healthcare system that only prioritizes well-being after the fact.  Tom follows the numbers that show that our problems are tied together – that mental health is tied to our housing crisis, our poverty crisis and increasing disparities.  “This growing outcome gap is related to the growing income gap.” 
 
So what is the path forward?  Tom writes, “My hope for our country, after all I have seen over forty-five years in the field, is to redefine mental health care to include recovery and prevention.”  He argues for measuring better outcomes and reimbursing for mental health care and recovery the same way we do for physical injury. 
 
It’s encouraging to see someone from the highest levels of government acknowledge the need for fundamental new approaches.  “Recovery is more than a reduction in symptoms:  it is the return to a full and meaningful life . . . It’s the three Ps.  It’s people, place and purpose.”  We need more of these for more people, both before and after they struggle. 
 
For my interview with Tom about his book, click here.  For the Good Life Movement click here.  To improve our politics and meet some awesome people in your community, check out Forward here.  For a presidential candidate who wants universal healthcare, check out Dean Phillips here.