There is a paradox that is at the center of our conversation about mental health in America. For one thing, our treatments for mental illness have gotten better and better in recent decades. Psychopharmaceuticals have improved considerably; new, more effective methods of psychotherapy have been developed; and we have come to a better understanding of what types of social support are most helpful for those experiencing mental health crises.
But at the same time, mental health outcomes have been moving in exactly the wrong direction. In the United States, there is a death by suicide about every 11 minutes, and about half of those who die by suicide have not received mental health care. Rates of anxiety, depression, and eating disorders have skyrocketed among young people in recent years. From 2009 to 2015, rates of visits to the emergency room for self-harm more than double for girls from 10 to 14 years old.
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Thomas Insel understands the contours of this disconnect better than anyone. A psychiatrist and researcher, he was director of the National Institute of Mental Health for 13 years and served as a special adviser on mental health care to California Governor Gavin Newsom. But in his new book, “Healing: Our Journey from Mental Illness to Mental Health”, admits that even the herculean efforts made by the mental health community have fallen short. The book explores how badly we are failing in mental health care and how much more we could do with what we have already discovered and what we already know. “Simply put, the mental health problem is medical,” she writes, “but the solutions are not just medical, they are social, environmental, and political.”
In this conversation, we discuss why our current medical system is so inadequate at helping people with mental illness of all kinds, why psychiatric research and patient outcomes are so out of date, the story of how the US government… The US systematically divested itself of mental health care. in the 1980s, and the fragmented care system those decisions created. We also mention why it is so difficult to find the right therapist; what treatments we know work really well and why we don’t use them so often; why mental health is not only a medical problem, but also an economic and social one; what public policy can and, more importantly, cannot do to solve our mental health crisis; the relationship between loneliness and mental illness; how the relaxation of family and social ties is affecting our collective mental health and more.
You can hear our entire conversation by following “The Ezra Klein Show” on Apple, Spotify, Google either wherever you get your podcasts. View a list of book recommendations from our guests here.
(A full transcript of the episode will be available at noon on the Times website.)
“The Ezra Klein Show” is produced by Annie Galvin Rogé Karma; fact-checking by Michelle Harris, Mary Marge Locker, and Kate Sinclair; mix of Sonia Herrero, Carole Sabouraud and Isaac Jones; original music by Isaac Jones; audience strategy by Shannon Busta. Special thanks to Kristin Lin and Kristina Samulewski.
