STORY AND PHOTOS BY KAREN BOSSICK

Dr. Thomas Insel was proudly rattling off the latest research on the stem cell studies of neurons in schizophrenia disorders when a father of a boy with schizophrenia stopped him cold.

“You don’t get it!,” the man yelled from the back of the room. “Our son is 24 and he has schizophrenia and he’s been hospitalized five times, in jail three times and he’s made two suicide attempts. Our house is on fire and you’re talking about the chemistry of the paint.”

It was a pivotal moment for Insel, the director of the National Institute of Mental Health who had directed billions of dollars into research on neuroscience and the genetics of mental disorders under President Obama.

Tyler Norris quizzed Dr. Thomas Insel on how best to care for the 14. 2 million people with mental illness.

Insel acknowledged to himself that science alone was not able to put out that fire. He left the mental health research world and began doing a deep dive into why the American mental health industry was not healing millions of people despite advances in research.

He began looking at what a better path to mental health might look like, and he shared what he learned in the book “Healing: Our Path from Mental Illness to Mental Health.”

“We are really crushing it economically, and we’re really lousy on all the measures related to well-being, including suicide,” he told a crowded lecture room at The Community Library Tuesday during a conversation with Tyler Norris, chair of the Blaine County Mental Well-being Initiative.

“We enjoy high productivity and great wealth and we have such poverty and unhappiness,” he added.

There are a bunch of things that are broken—we’ve been paying for a lot of stuff that doesn’t work, Insel said during the program hosted by St. Luke’s Wood River Foundation.

Medical treatments have not been as effective as scientists thought. We don’t do a good job of engaging people in care or measuring outcomes. But there is a lot we can do, Insel said, and some of the things that are most effective don’t look like our health system…they aren’t about clinics.

Insel said he asked a psychiatrist who works on Skid Row in Los Angeles about recovery. “It’s simple,” the man told him: “The three Ps.”

“I was thinking: Prozac, Paxil, maybe psychotherapy,” Insel said. “But his three Ps were people, place and purpose.”

People need people’s social support. They need a place to live and reasonable nutrition.

“And you’ve got to have a reason to get up every morning, something to care about. People today often don’t have that sense of purpose,” Insel said.

Insel noted that for the first time since its creation in 1965 he cannot be sure about the sustainability of Medicaid. It’s stunning, he said, that the $800 billion program could be led by a man who doesn’t understand it. And scary, given that 44 percent of Americans are eligible for the health insurance program.

We need to be looking at whole person care, he said. Currently, programs do not take into consideration that someone with schizophrenia, for instance, might also have a substance abuse problem and trouble securing housing. Combining medication with psychological and cognitive therapies, family support and academic and employment support can help these people recover—the earlier they’re treated, the better.

Insel said the youth mental health crisis has grown tenfold during the last 15 years, in large part because of drugs—100,000 Americans die each year from fentanyl overdoses. Anyone who wants to experiment with recreational drugs use today must realize that they could die from their first use, he added.

Social media, lack of sleep, societal and academic pressure could be driving some of the problems with youth, he said: “There’s a whole generation out there that has not recovered from the pandemic.”

Asked about psychedelics, Insel said that the field is still experimental and we don’t yet know about their effectiveness for depression. The research is promising for PTSD, but there are possible cardiovascular risks. “We need to know more,” he said.

“My concern is that they fit into this chronic sense that we’re going to have some magic bullet.  I think they will get approved, but it won’t be the magic bullet people think it will be.”

A form of ketamine given via IVs or nasally seems an effective rapid treatment for depression and suicidal ideation, he said. The downside is it doesn’t last. “Most antidepressants take four to six weeks to kick in; this kicks in in four to six hours.”

Insel said the microbiome is an interesting new science for understanding behavior.  Also not studied enough is microplastics, which have been found in the brain of people with dementia.

Asked about Artificial Intelligence, Insel recounted a case where AI was consulted about a woman who was concerned about gaining weight from the lithium she was taking for bipolar disorder. AI offered alternatives. And it suggested that the woman remember why she was taking the lithium. If you have a good relationship with your fiancé, it’s likely he loves you for who you are and would not want you to risk a relapse, it said. So, said Insel, when you compare AI to an overworked physician for accuracy and empathy, it might come out better.

“It can even communicate in emojis to teens.”