HEALING

The former director of the National Institute of Mental Health diagnoses and prescribes cures for a mental health care system that’s “a disaster on many fronts.”

In his first book, psychiatrist and neuroscientist Insel explains an apparent paradox of mental health care: “Current treatments work,” but too few people get their benefits, and outcomes for the U.S. as a whole remain “dire.” Arguing that the crisis exists “because we fail to deliver on what we know, or we fail to use what works,” the author often slights evidence suggesting that the poor results persist because some common treatments do not work or are overused rather than underused. He ignores, for example, well-regarded studies that have found that depression and ADHD are overdiagnosed and overtreated, and he oversells some treatments he supports. For readers who can live with Insel’s overly bullish view of certain remedies, however, this book offers a wealth of fresh, clear, and mercifully jargon-free facts and insights into America’s mental health care problems and possible solutions. The author links the crisis to the Reagan administration’s slashing of federal spending on community health and its scaling back of support for the “deinstitutionalization” promoted by John F. Kennedy and others. He also describes the potential benefits of “supported education and employment” programs and of controversial technology like digital phenotyping. In the strongest chapters, Insel shows how current U.S. policies have ravaged the poor, the homeless, and the incarcerated; the U.S. has so few hospital beds for the mentally ill that some police do “mercy bookings,” which let people get care in jail that hospitals can’t provide: “The Los Angeles County Jail and Chicago’s Cook County Jail are now the largest mental health institutions in the nation.” Insel makes clear that such mental health conditions involve moral and civil rights issues, adding important dimensions often neglected in similar books.

Despite a few unpersuasive arguments, this is a formidable entry in the field of books about the mental health crisis.