Book Review – Healing
Image: Healing by Len Lantz (CC BY-NC-ND)
Synopsis: Len's Star Rating: 10 out of 10. An exceptional book on problems and solutions for the US mental health system.
BY LEN LANTZ, MD / 10.26.2024; No. 127
Disclaimer: Yes, I am a physician, but I’m not your doctor, and this article does not create a doctor-patient relationship. This article is for educational purposes and should not be seen as medical advice. You should consult with your physician before you rely on this information. This post also contains affiliate links. Please click this LINK for the full disclaimer.
Star Rating – 10 out of 10
Rating guide: 1 = horrible, 5 = average and 10 = wow
Author
Thomas Insel
About the author
Thomas Insel, MD, is a psychiatrist, researcher, and former National Institute of Mental Health (NIMH) director. He led the Mental Health Team at Google’s Verily after his tenure at the NIMH. He has served as a special advisor to the Governor of California, and he co-founded MindSite News, a nonprofit news publication. Dr. Insel has also been active in mental health organizations and startup companies, including co-founding Mindstrong Health, Vanna Health, and Humanest Care.
General description
In Healing, author Thomas Insel covers the US mental health system landscape, including what’s working and what’s not. He points out numerous reasons why the US does not have better mental health care and what he believes has to be done to bring about needed reform. Dr. Insel shares that we have treatments that work and need to get the most effective therapies to people in our communities at scale. The author’s approach to a rational and effective mental health system centers on his three P’s of recovery (people, place, and purpose) from mental illness. Topics covered in this book include:
Advocating for mental health parity (paying for mental health care similarly to physical health)
Reducing stigma for mental health treatments
Explaining how effective mental health treatments are
Sharing the hope of improved treatments through precision medicine
Demonstrating the need to prevent mental illness
Providing recommendations for policies and programs that will ensure that more people have access to the most effective care
Unique and most important aspects
Thomas Insel’s Healing is a fresh perspective on the problems that we have in the US mental health system with actionable ideas for needed change. While the author shares examples of how our mental health system is failing, he does not oversimplify the problem as he explains why the system is failing.
Dr. Insel demonstrates how a lack of health insurance parity, inadequate funding and leadership at the federal level, and mental health stigma are a recipe for a mental health system in the US that fails to meet the needs of individuals and families. His chapter “Beyond Stigma” is exceptional and alone justifies the purchase of this book.
As a fellow psychiatrist, I share many of the concerns that Dr. Insel covered in Healing. The lack of access to quality services is a social justice issue. It’s disturbing that our country and local communities cannot “get it together” to serve our most vulnerable people.
As former US Representative Patrick Kennedy said, “The mental health crisis has become the civil rights issue of our time.” In Healing, Thomas Insel provides the roadmap to fix our broken mental health system. We must come together with a collective will to make it happen.
Important features of this book include that it:
Explains reasons for poor outcomes when mental health treatments are effective
Effective individual treatments are rarely combined to provide necessary comprehensive care
A knowledge gap exists in selecting treatments for specific individuals
Crisis-oriented attitudes and negative attitudes toward treatment block people from better outcomes
Shares the success of the 988 crisis line
Documents the systematic cutting of community mental health funding since the 1960s
Reveals the tragedy of “transinstitutionalization” (substituting long-term hospital care with jails and prisons)
Describes the three significant barriers to quality care
The majority of the available therapy workforce has not been trained in evidence-based therapies
Care is fragmented
There is limited accountability because many mental health providers do not measure outcomes
Outlines how Improving Access to Psychological Therapies (IAPT) offers better training to therapists and results in better quality care and better outcomes
Gives details on the Friendship Bench intervention in Zimbabwe
Best quotes
“Recovery is more than a reduction in symptoms: it is the return to a full and meaningful life.”
“We do not have a mental health system. At best, we have a mental sick-care system, designed to respond to a crisis but not developed with a vision of mental health that is focused on prevention and recovery.”
“We now understand that social factors (your zip code, not your genetic code) and lifestyle choices (how you live, not how many medications you take) are much more important for health outcomes than your specific diagnosis or health care plan.”
“In my journey across California, I spoke with billionaire tech moguls in Silicon Valley, middle-class families in the suburbs, and homeless people in cities. They all used the same word to describe modern mental health care: ‘broken.’”
“We must remember that there was a time when America was kinder to those with mental illness, providing care that was imperfect but comprehensive, consistent, and compassionate. It was a time when death and disability, incarceration and homelessness, were not common consequences of having a mental illness.”
“With so many forensic patients occupying beds in public hospitals, an increasing number of people with mental illness are being incarcerated in jails and prisons as so-called mercy bookings.”
“With deinstitutionalization, or what might be more accurately called transinstitutionalization, policies that limited hospital access for people with mental illness created an on-ramp to the criminal justice system.”
“Better outcomes require improvements in quality of care as well as access to care.”
“The tragedy is that, to pervert a legal expression, treatment delayed is often outcome denied. A delay in starting treatment for these illnesses means that the outcome is likely to be worse.”
“In nearly every conversation I had with families and advocates, they pointed to ‘stigma’ as the biggest problem in mental health.”
“The term stigma more accurately describes negative attitudes toward treatments.”
“It is important to realize that the choice between individual liberties and public safety can be a false dichotomy. Often the choice is not between individual rights and public safety but between an individual’s illness and personal safety.”
“Our grandchildren will no doubt wonder how, in the presence of good treatments, we banished people with brain disorders to jails and homeless shelters.”
Who would enjoy this book?
Readers looking for a book explaining the reasons for our broken mental health care system and ideas for fixing it will likely enjoy Healing.
Who would not enjoy this book?
Readers who do not support evidence-based therapies in the treatment of mental illness are unlikely to enjoy Healing.
Conclusion
Healing is an exceptional book on problems and solutions for the US mental health system.