'Healing' Review: More Help for Mental Health, Please
It may be surprising to learn that serious mental illness—such as schizophrenia, bipolar disease and severe depression—afflicts about one in 20 Americans. Some of us have encountered these conditions in the experience of family members. Others see it routinely on display on city streets. By now, as Thomas Insel notes in “Healing: Our Path From Mental Illness to Mental Health,” we know much about the brain and about the ways in which it can malfunction. Yet the outcomes for people treated for serious mental illness are often poor, he says. Why?
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The statistics are depressing. Only about 16% of people with severe mental illness are receiving even “minimally acceptable” treatment. Many of the others land in jail cells or squalid street encampments, or languish in back bedrooms. Psychiatrists are heavily concentrated in high-income urban areas, with half of all U.S. counties having no psychiatrists at all. Paying for treatment can be a challenge, too: Almost 60% of psychiatrists don’t accept Medicaid, and 45% don’t accept private insurance. There are only 12.6 public hospital beds for mentally ill patients per 100,000, a quarter of what analysts estimate we need.
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The University of Washington in Seattle has perfected so-called collaborative care. A staff member is assigned to focus on “the people who may not be asking for help or might be falling through the cracks,” as the program’s director puts it. “This person’s job is to integrate medications and psychotherapy with programs aimed at meeting social needs.” Dr. Insel emphasizes that well-designed programs for recovery should aim at “finding connection, sanctuary, and meaning not defined or delimited by mental illness.” Ideal long-term care, after initial contact, would include the sustained attention of a team, including a social worker and an occupational therapist. One goal would be to help the patient navigate a return to school or work, thus avoiding isolation and self-destructive rumination.
Because Dr. Insel is such an understated writer, it is easy to miss the audacity to be found in “Healing.” He confesses to having long “misunderstood the problem” of treating mental illness—as did most of the profession he helped to lead for two decades. “While we studied the risk factors for suicide, the death rate had climbed 33%,” he writes. “While we identified the neuroanatomy of addiction, overdose deaths had increased threefold. While we mapped the genes for schizophrenia, people with the disease were still chronically unemployed and dying 20 years early.”
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https://www.wsj.com/articles/healing-review-more-help-for-mental-health-please-11647207100 (subscription)