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Erin Knox, PharmD, BCPP
Director of Experiential Education
UCI School of Pharmacy & Pharmaceutical Sciences
Irvine, CA

We have unprecedented progress in neuroscience…yet outcomes are no better.

Dr. Tom Insel, MD introduced his keynote presentation at CPNP’s 2022 Annual Meeting with this sobering statement, preparing the audience for a discussion on strategies to follow the path from mental illness to mental health. The session learning objectives highlighted that health is about more than just health care and that the road to recovery for people with severe mental illness (SMI) includes multiple facets. Described by attendees as “an engaging and compelling speaker,” Dr. Insel led the audience through a “thought-provoking and inspiring” review and proposed solutions to the mental health crisis in the U.S.

In describing evidence of the crisis in behavioral health, Dr. Insel reviewed data from the CDC from 2020 to 2021 which identified an increase of 28.5% for substance overdose deaths compared to 2019-20.1 Dr. Insel reviewed deaths of despair, which include deaths from suicide, substance overdose, and alcohol use.2 Common reasons used to explain this crisis were systematically disproven by Dr. Insel, including lack of effective treatments, too few therapists, too little funding, low understanding of pathology, and stigma. Rather, Dr. Insel highlighted well-supported reasons: the lack of engagement, lack of quality, and lack of accountability.

In the US, approximately 53 million people have a psychiatric disorder, with approximately 14 million defined as serious.3 As few as 40% receive services, 40% receive care defined as minimally acceptable, and only 33% of those experience full benefit.4 This lack of engagement is viewed as a substantial contributor to the care crisis for mental health.

Training in evidence-based treatments may contribute to a lack of quality of care provided to individuals with mental illness. Approximately 60% of social work and psychology training programs do not require didactic or clinical supervision in EBT, demonstrating a gap between practitioner and effective care modalities available to patients with mental illness5.

Building on the paucity of quality care available to individuals, Dr. Insel also described a lack of accountability, with less than 20% of practitioners engaging in measurement-based care processes6.

Dr. Insel continued the discussion by proposing several solutions. Technology was suggested as a multi-dimensional method of supporting current processes, with digital care positioned to improve the current mental health landscape. Beyond technology, Dr. Insel described the development of supporting policies, such as a new crisis line, increased health facility capacity for people with severe mental illness, and alternative methods for value-based payments.

As a central theme of his presentation, recovery was emphasized as Dr. Insel described the three P’s: people, place, purpose:

  • People: loneliness drives medical complications for those with SMI7
  • Place: poverty increases risk factors for mental health issues
  • Purpose: people with mental illness can use their lived experiences to help others on the path to recovery

To highlight considerations in solving the crisis, Dr. Insel implored the audience to think beyond symptoms, creatively redefine care, and target recovery as a social movement.

Take home points:

  • Mental health care is in crisis and opportunities exist for improvement in engagement, quality, and accountability.
  • The three P’s are crucial for the road to equity: people, place, and purpose.
  • The problems are defined as medical, however, recovery will require, social, environmental, and political solutions.

References

  1. Centers for Disease Control and Prevention. (2022, June 15). Products - vital statistics rapid release - provisional Dr.ug overdose data. Centers for Disease Control and Prevention. Retrieved June 15, 2022, from cdc.gov/nchs/nvss/vsrr/Dr.ug-overdose-data.htm
  2. Sterling P, Platt ML. Why deaths of despair are increasing in the US and not other industrial nations—insights from neuroscience and anthropology. JAMA psychiatry. 2022 Apr 1;79(4):368-74.
  3. The NSDUH report. Rockville, Md. :Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Dept. of Health & Human Services 2020. 2022 Jan 11. Retrieved June 15, 2022, from https://www.samhsa.gov/data/report/2020-nsduh-detailed-tables.
  4. Merikangas KR, He JP, Burstein M, Swendsen J, Avenevoli S, Case B, Georgiades K, Heaton L, Swanson S, Olfson M. Service utilization for lifetime mental disorders in US adolescents: results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry. 2011 Jan 1;50(1):32-45.
  5. Weissman MM, Verdeli H, Gameroff MJ, Bledsoe SE, Betts K, Mufson L, Fitterling H, Wickramaratne P. National survey of psychotherapy training in psychiatry, psychology, and social work. Archives of general psychiatry. 2006 Aug 1;63(8):925-34.
  6. Lewis CC, Boyd M, Puspitasari A, Navarro E, Howard J, Kassab H, Hoffman M, Scott K, Lyon A, Douglas S, Simon G. Implementing measurement-based care in behavioral health: a review. JAMA psychiatry. 2019 Mar 1;76(3):324-35.
  7. Fortuna KL, Ferron J, Bianco CL, Santos MM, Williams A, Williams M, Mois G, Pratt SI. Loneliness and its association with health behaviors in people with a lived experience of a serious mental illness. Psychiatric Quarterly. 2021 Mar;92(1):101-6.
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25 Years!