Thomas R. Insel, M.D.

Attaining mental health from pervasive mental illness presents a contemporary challenge to the American healthcare system. Decades of progress in the basic science have not resulted in progress among outcomes, sadly. This reflects a broader observation that scientific advances have not been accompanied by necessary social advances. After a lifetime spent bettering patients’ lives as a psychiatrist and researcher, Thomas Insel here points the way to what an America with true mental health would look like and to how we can get there.

As a former director of the National Institute of Mental Health (NIMH), Insel sat in a privileged position to see and direct federal expenditures for research into mental illness and mental health. In this book, he concludes that most of the therapies that we have indeed work; the problem is that the “social determinants of health” (in other words, your zip code) have a far greater impact than the treatments themselves. Today, limits to access and community/familial support matter more to good psychiatric outcomes than anything else. This points us how to focus our help better.

After a decade at the NIMH under Republican and Democratic administrations, Insel went west to California to help with innovative software projects in Silicon Valley that promise to disrupt how individuals receive diagnosis and treatment. Despite this technological effort and despite exploring biologic markers of psychiatric disease in the lab, he concludes that the social domain is where we need to concentrate future efforts and dollars. Our system simply does not reward practitioners for outcomes, only for giving treatment, and this needs to change.

“Mental health” is a buzzword in today’s news every time bad things happen. However, the popularity of these words is not matched by corresponding depths of exploration. Reading Insel’s book can change this. He’s balanced and realistic about the challenges that we face. Many books on mental health turn into opinion-based, semi-political diatribes that stray from scientific findings. This book does not. It informs and reasons first. Filled with patient stories, it is also approachable for those with mental illness or those affected by mental illness. Psychiatric patients – and who doesn’t know one these days? – can learn how to have better mental health themselves and to help their friends, neighbors, and family to achieve this, too. Coming from a psych patient myself, it’s high time we do something big about mental health, and Insel’s roadmap is one I can support fully.… (more)