#book [[Books Index]] [[why is there mental illness]] #mental_health #Mental_Illness [[Systemic Thinking]] ---- # Healing: Our Path from Mental Illness to Mental Health Thomas Insel, MD Penguin Press New York, 2022 CONTENT PART 1 A CRISIS OF CARE 1. Our Problem 2. Alien to Our Affections 3. Treatments Work PART 2 OVERCOMING THE BARRIERS TO CHANGE 1. Fixing Crisis Care 2. Crossing the Quality Chasm 3. Precision Medicine 4. Beyond Stigma 5. Recovery: People, Place, and Purpose PART 3 THE WAY FORWARD 1. Simpler Solutions 2. Innovation 3. Prevention 4. Healing ---- INTRODUCTION Author was the Director of the National Institute of Mental Health (NIMH) [[202403091732 Solving mental health problems requires not just a medical but also a social, environmental and political approach]] [[202403091733 Recovery is about creating meaning - and purpose]] [[202403091734 Do we have a mental health care system or a mental sick care system]] [[202403091734 Why do current treatments not work]] [[202403091735 How we use what we have makes the difference]] [[202403091736 Healthcare treat the 10 percent, life outside hospital impact 90 percent]] [[202403091737 Mental health is a system issue]] [[202403091747 Involve family members to care for patient]] ---- **PART 1** **A CRISIS OF CARE** **CHAPTER 1 : Our Problem** - Mental illness is deadly due to suicide and health issues but may not be treated. - Patients with mental illness have shorter life expectancy compared to the general population. - High prevalence and early onset means a life with a disability ("years of productivity life lost). The trend increased by 43% from 1990 to 2016 - The author finds it mystifying that society does not find this mental illness a crisis - the equivalent of a 747 full of people crashing every two weeks. - [[202403102045 Mental health crisis is a crisis of care]] A Different Approach - [[202403102048 what works to help patient is community care]] - [[On Prodrome and Relapse]] - [[202403102054 The Idea of a Mental Health Crisis Management Hub]] --- This is a great idea! Exceptionalism - The model that works for medical illness, find the singular cause and a singular solution, does not work in mental illness. Perhaps because there is no single cause? - "The model positing a singular cause and searching for a singular solution might still be workable in many areas of medicine, but it has not yet been successful for mental illness." - **"More-care-but-worse-outcomes**" conundrum. We have more resources (clinicians, medication, therapies) now, but we have more patients and more deaths. Why? - Patients are not "in care", because of poor engagement. They do not take the medication given. - The author said that the problem is with care delivery. *"Limited engagement in care and ineffective delivery of care are clearly huge obstacles for people with mental illness*." - 60% of people not in care because of "attitudinal barriers" - like wanting to deal with the problem alone. They do not think they have an illness, so they reject care. - Depression: Hopelessness is a barrier to seeking care. - Anxiety: Avoidance - Not about blaming the person with illness, but recognising the very nature of these disorders makes it more difficult to bend the curve. - If the patients are not receiving care, then where do they show up? They suffer out of sight and we may see the problem as homelessness, crowding in jails and prisons. **CHAPTER 2: Alien to our affections** - History of mental illness has been a long one. - Introduction of hospital, asylum in early 19th century, Phillippe Pinel in France, William Tuke in England, and Dorothea Dix in the US advocated for humane treatment of people with mental illness - nearly 600,000 were in state hospitals by 1963. - The history of American deinstitutionalisation in the 1950s. Thanks to President Kennedy and the introduction of the Community Mental Health Act. **Camelot** - We provided much more than medications at the Berkshire Medical Center: we followed patients intensively, we had a stepped approach to help people following hospitalization, and we saw people recover. In a word, we were accountable. Whether the person was at home, in school, in our clinic, or in the state hospital, we were responsible for their care **The Fall**