Leadership Series: Mental Health Policy in 2021

Three mental health experts joined State of Reform on Thursday for a conversation on mental health policy in 2021 as part of our virtual “Leadership Series.” Joining the conversation was Thomas Insel, MD, Mental Health Czar at the Office of California Gov. Gavin Newsom, Susan Mims, MD, Interim CEO at Dogwood Health Trust, and Andy Keller, PhD, CEO at Meadows Mental Health Policy Institute.

Insel kicked off the conversation with comments on how the country is doing as it relates to mental health. He points to levels of anxiety, depression, and overdose deaths which are all on the rise.

“We’re feeling, I think, the impact of having a system that was broken even before the pandemic,” said Insel. “I think most consumers will experience it as broken. Many providers as well and certainly the payers would say that. But it’s unfinished and we have a lot of work to do.”

Keller agreed that the mental health system feels broken, but he says he would describe it as “misdesigned.” He says the system has been designed on fundamental inequities and bias which make it difficult for individuals with mental illness to receive care. Mims says the pandemic has helped shine a light on these broken systems, making them impossible to ignore.


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Keller and Insel also offered their thoughts on the difficulties in addressing suicide rates in the United States, which stems from the lack of timely data collection and the inability to monitor the situation.

“The problem with suicide is we just don’t surveil it in the same way we do other illnesses,” said Keller. “I can tell you yesterday a pretty good guess as to how many people died from COVID, but we won’t know until early 2023 how many people died this month from suicide.”

Insel says there are about 48,000 suicides in the United States every year – more than double the number of homicides in the country. The rate of suicide has gone up about 33% in the US since 1999, while in the rest of the world, with a few exceptions, the global rate of suicide is down by about 38%, he says.

“So, the United States is really exceptional in this sense. We have managed this worse than just about any other developed county. And it is one place where I think it is reasonable to ask for a federal leadership role,” he says.

Part of the strategy to address suicide in the US is better monitoring, early intervention efforts, and “postvention,” he added.

In her comments, Mims stressed the importance of addressing the social determinants – such as housing, education, and economic development – and moving upstream to improve health and wellbeing.

“We know that someone really can’t focus on getting the care that they need…until they have a safe place to sleep and a safe place to live,” she says.

And on top of these issues, she says providing services that address the social determinants of health need to have an equity focus.

Insel also discussed the use of technology in behavioral health care. A recent report indicates there has been a $1.4 billion venture capital investment in the last year for behavioral health technology – which is about what the National Institute of Mental Health (NIMH) spent last year, he says, for research and new projects.

He says there’s a lot of opportunity in technology, but he is concerned that a lot of that investment isn’t going toward solving the problems that exist in the public health system.

The full conversation is available in the video above.