I'm Jim Gruber and Associate Professor of Psychology at the University of Colorado Boulder and director of this mental health expert series. I'm here today with Dr. Thomas Insel founder of Humanest Care and former president of Mindstrong Health and director of the National Institute of Mental Health. So thank you for being here today. >> I'm delighted to be here June. >> I was wondering if you could start by telling us about the kind of mental health work you're doing right now. >> Yeah, I'm separating my life into three chunks right now. I'm spending quite a bit of time working on a book about transforming mental health care book is called Recovery. It will be out in 2021 or hopefully and it really goes after the question of how do we get better outcomes? How is it that we can take what we know is working for people and make sure that is what we do in the real world of care? So that's been a labor of love, I've been at it for a couple of years. And finally, trying to bring that to closure by the end of 2020. I also have launched Humanest Care which is the startup which is an online mental health site. It's a digital gathering place for people who are looking for support and also people who not only want to get help but want to give help. So it's a community that we're building, that's a mental health community. You can think of it a little bit like a online, but it's membership based and it includes also groups and workshops and getting one-on-one care. It's a little bit like peloton for mental health where you can get coaching and you get a dashboard and you have goals. Well, it's pretty interesting, just launched a couple of weeks ago. We're really excited about building that out and becoming the anti-Facebook, if you will, someplace where people come together in a more authentic way. And we're building out collectives of small groups of people to help each other. The third thing I'm working on is this idea I had that really came out of the humanest process. I'm realizing that we need a lot of innovation in this field. Not so much in just diagnostics and therapeutics, but more than just the way we deliver care. What we're able to do to make sure that people get the things that work. And so when I launched Humanest I thought this is one of maybe ten companies that needs to be developed. And it's pretty hard to do ten companies yourself, so I created a venture fund. Now $100 million fund to try to support entrepreneurs who want to launch companies to transform mental health care. And we're still in the process, we're still raising the money, $100 million sounds like a lot of money, it is, and it takes time to actually pull all that together. But I've gotten together with a group of people to co-found this and we're trying to now put the pieces in place that we can begin to support some startups. And assemble some companies, support some that have already been assembled. But really direct people towards the tools that I think will need to build over the next decade, to really change the way that people get care and the way they can recover. >> I mean, that is phenomenal and such a needed paradigm shift in our field of mental health care. And I am just wondering if you could say a little bit about how you got started in this kind of work? >> Mostly through frustration, I had been at NIMH, I was there for longer than any director my guess since the 1950s. So I was there for 13 years and spent a lot of money and support a lot of really great science. It was just an amazing time from 2000 to 2015 to see how the revolution in genomics, the revolution in neuroscience, neuroimaging, the brain initiative. All of that was really creating hugely interesting new insights. But I wasn't really changing the role for people with a mental illness. So if you has schizophrenia or severe depression or bipolar illness, in 2015, you really want to look better off than you were in 2002, arguably you were worse of. And I began to feel that wasn't okay, it wasn't that I necessarily thought that and I made should drop everything it was doing and just get into the game of improving outcomes. I mean, we do need fundamental research and we need an agency that does that. But for me personally, it wasn't feeling good anymore to be focusing so much on supporting people to write papers when it was having almost no impact on the real world of healthcare. And the fact was, even the 50% or so of people with mental illness who weren't even in health care and who were languishing in jails and prisons or hoover in homeless encampments. In those 13 years, we really saw, I think that the social safety net was more shredded every year. And so the outcomes for people got considerably worse. In fact, the suicide rate went up almost 30% during that period of time. That's untenable, I mean, I just was feeling that I didn't want to spend another 13 years seeing that continue. So the question became, how do you bend the curve, how do you make a difference? And my first move was to leave, when I left NIMH, I moved to Google, I was an executive at Verily. Which is a company we spun out of Google trying to really focus on software, hardware for healthcare. And the question was, could we really build the products to have an impact on mental health? And Google does that kind of stuff. Google thinks big, they are only interested in products used by a billion people every day, less than a billion doesn't count. I remember the first couple of weeks I was there, I had a friend who was editor in chief at Nature. And he asked me if I'd write a review a paper about the transition. And I just checked with the CEO and the head of our PR department at Verily about doing that. And they said, why would you do that, why would you write a paper for Nature that is a complete waste of your time? That's just a distraction, we're here to build products, we're here to make a difference, we're here to do something that a billion people will see. You write a paper in a journal like Nature and maybe a hundred people will read it, maybe a thousand, but we're not in that game any more. We can do much better, we can have an impact in the real of care, we can have an impact by building stuff that people use. And in fact six months in I was working with the search team, we put in those little profiles that go in for different terms and healthcare. Little boxes we built them for all of the mental disorders. And they were right within a weekend we had over a million people who saw everything that we wrote out over the course of a few hours. I mean, there are other ways of getting information out and using science and using evidence. So we will have an impact on how people address about they're struggling with. I just began to feel that the academic world must be doing that. And that we were mostly talking to each other and working really hard to promote our own careers. And getting very invested in publishing in a few journals that actually very few people read. It was probably a useful enterprise but not a relevant one, it wasn't really having any impact on public health. >> So along those lines, in terms of having an impact or real world impact for public health, what do you see as the most important next steps in the field? >> Well, I think there are huge gaps and one of them is this gap between what we know and what we do. And so, that plays out in several ways, most people focus on the problem that we have with access that so many people who are struggling with a mental illness don't have access to care. And I think that is a real problem, to me the bigger problem is the quality problem that even when you get access, what you get access to may not be very good. And what I struggle with is the way that so much of what's done in the realm of psychological therapies doesn't really match up with the evidence base that we have with what we know works. People do psychotherapy, they call that psychotherapy, but it's not really the therapies that we know are effective. We wouldn't allow that to happen in the treatment of cancer or heart disease or hypertension or diabetes. It's just there are standards that people have to meet, somehow we don't take mental health care that seriously. And so people are allowed to do whatever they want to do for the most part as long as they're licensed. There isn't a kind of system of measurement and a system of accountability. And without that it's very hard to fix the quality problems. So I think those are things that we need to start focusing on, is how to improve quality as well as access. How to begin measuring in a way that can build accountability into the system. And how to make sure that people are looking at outcomes, not just the process. So we begin to ask ourselves are we reducing suicide, are we making sure that people with serious mental illness are getting to work? Really focusing on recovery, not just the reduction of symptoms. Do we address depression as just a problem that needs a pill or are we looking at it as a problem that needs a more comprehensive approach with the combination of medication and psychotherapy and some rehabilitative services. All of those things the way we would do diabetes or heart disease. Somehow in this field we have allowed quality to really languish and we're not doing the things that we know work. And we're not doing them at the dose that is required or with the integration of care between psychological and medical approaches. >> So my final question for you sort of on the heels of this topic is what advice would you have for others who are watching this interview today? Maybe they're students, maybe they're mental health professionals, maybe just the public at large who are interested in mental health and do want to make a difference? >> Well, June, I'm really hopeful, I do think that if you wanted to make a difference for COVID right now, it's tough. We don't have a drug, we don't have a vaccine. In the case of every mental disorder we have stuff that works, we do and people forget about that or they neglect that. So I think if you're somebody in training or somebody who's interested in this field. I would say, hey, you learn the stuff that works, get really good at it, think about the opportunities we have today to be innovative. So the ways in which you can do remote therapies, the ways in which you can combine treatments. The ways in which you can create opportunities that were not possible even a decade ago to be able to help people monitor their own symptoms. Empower them with stuff that's available on the web that's can be of high quality if you do it right. So I think for people coming into the field now, we could actually bend the curve. There's a lot we can do, but we have to focus on outcomes. We have to be accountable, we have to get past the kind of legacy we've had. That says that these are simple problems that will respond to singular solutions. That if I have a hammer, it's okay for me to treat everybody like a nail. Those are legacy of in the field that we have got to examine and get ourselves free from. And some of that will be recognizing that these are hard problems and that we can begin to take the things that work combine them. But we also have to be humble about all that needs to be done still. >> Well thank you for such a eloquent and meaningful response. And thank you so much for speaking today. >> My pleasure, hope this is helpful and I love the fact that you're doing this and getting lots of people to weigh in because these are important problems. It's going to take a village to be able to make an impact. Thanks so much.
