Healing

Starred review from November 8, 2021
Insel, former director of the National Institute for Mental Health, debuts with a profound diagnosis of the ills and promises of the United States’ mental health-care system. Insel admits that during his tenure as the “nation’s psychiatrist,” he struggled to grasp the problem underlying the country’s mental health crisis: “Our science was looking for causes and mechanisms while the effects of these disorders were playing out with increasing death and disability, increasing incarceration and homelessness, and increasing frustration and despair.” In breaking down how mental illness became so pervasive, Insel explains the history of health-care policy in America, covering the Kennedy administration’s revolutionary attempts to supporting non-institutional care and the Reagan administration’s slashing of community health-care budgets. Insel offers a solid history of how systemic issues such as homelessness, mass incarceration, and for-profit health insurance keep the country tied to ineffective means of treating mental illness. But it’s not all doom and gloom: he offers a sense of hopeful solutions, including an expansion of community-based mental health programs, the use of technological innovations such as “digital phenotyping” that can help keep track of how people behave outside of clinics, and initiatives that provide employment, housing, and social connection. It’s as compassionate as it is comprehensive.

December 15, 2021
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.

COPYRIGHT(2021) Kirkus Reviews, ALL RIGHTS RESERVED.

January 14, 2022

Rarely does a book come along that has so much potential to influence American policy and quality of life as this one does. In order to effectively deal with any crisis, it is important to understand the factors that created it. Here psychiatrist/neuroscientist Insel (former director, National Inst. of Mental Health) describes the current mental health care crisis in the United States in plain terms. In clear detail, using extensive research and narratives, many of them personal, he defines the social factors that have led to this crisis. Insel asserts that U.S. society already has the tools necessary to deal with and even eradicate this crisis. Educating the public, he believes, and lessening or eliminating the stigma attached to mental illness will allow the nation to properly arrange--and utilize to their fullest--the resources that are already available, thus allowing healing instead of continually providing expensive, temporary patches. VERDICT Readers of this important book will gain a greater, more complete understanding of mental health issues in the United States and will be pointed toward steps that could lead to radical change in mental health care. Recommended for all libraries.--Steve Dixon

Copyright 2022 Library Journal, LLC Used with permission.