From mental illness to mental health

While working as director of the National Institute of Mental Health, Thomas Insel, MD, a psychiatrist and neuroscientist, delivered a speech to an audience about the exciting advances taking place in teaching hospitals in understanding the mechanisms of the brain.

Someone in the audience stood up and said, “Man, you just don’t understand.” He went on to explain that his 24-year-old son suffers from schizophrenia and has suffered multiple hospitalizations and stints in prison, attempted suicide and is currently homeless.

“Our house is on fire and you’re talking about the chemistry of the paint,” Insel recalls.

It was a turning point in Insel’s approach to the mental health crisis plaguing the United States and, despite advances in therapies and treatments as well as increased monetary investments, has continued to worsen. during the last years.

“It actually blew me away,” Insel said, speaking at Learn Serve Lead 2022: The AAMC Annual Meeting on Nov. 14 during a session called “Healing: Our Path from Mental Illness to Mental Health.” “That’s when I thought, ‘Not everything we’ve done is responding to the urgency of a public health crisis.'”

Due to the failure of the US health care system to maintain an adequate mental health care infrastructure, even as medical advances reduce mortality from common physical ailments like cancer, stroke, and AIDS, “Deaths of despair” – as a result of suicide, drug overdose, or alcohol consumption – have increased, Insel said.

“We have almost 3 to 4 times more room than at the beginning of the century,” he said, adding that, for people under 34, the “deaths of despair” killed almost 15 times more people than COVID. -19 since January 2020.

The crisis is driven by five issues, according to Insel: lack of capacity due to the federal government’s disinvestment in mental health care infrastructure in the 1980s; lack of commitment, which means people in need do not ask for help; lack of quality care; lack of accountability due to virtually non-existent data reporting; and equity issues that discriminate against people with mental illness.

But as dire as the current outlook is, Insel said he had reason to be optimistic because there is evidence these conditions can be successfully treated, not just with therapy and medication, but with social supports. that give people a purpose in life.

Insel proposes to incentivize the creation of systems that can help prevent people from getting to the point of crisis, which ultimately costs more in emergency room visits and hospital stays. He is also encouraged by what he sees as the beginning of a shift in policy approaches at the federal level and in some states.

“The answer, I think, is that we start to expand what we mean by health care,” he said. “[And] to teach your students that what they need to think about is not just what they will learn in the emergency room and in an inpatient care unit, but rather engagement. It’s about figuring out how to meet people where they are… Yes, the problem is medical, but the solutions are social, environmental and political.

Insel also stressed the importance for the medical profession to be aware of the mental health needs of its own workers, especially medical students, who suffer from depression at a higher rate than the general public.

“Going to medical school is not like being vaccinated against mental health issues,” he said. “If anything [they] are more at risk, and we tend to tell our students that they need to be strong for everyone else. But we have to tell them that it’s normal not to be well. It’s normal for them to seek help for themselves.

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