Behavioral health in America is at a critical juncture, with rising rates of substance use disorder (SUD) and the pandemic leading to more people seeking help for a variety of issues. But when it comes to Americans having access to assistance, Tom Insel feels there is room for improvement with service delivery.

“More people are getting more treatment today than anytime in the past,” remarked Insel. “In spite of all this, we’re failing on outcomes. How does that make sense?”

Insel is the former director of the National Institutes on Mental Health (NIMH) and has been an advisor on mental health issues to California Gov. Gavin Newsom. Insel addressed his concern about behavioral health outcomes last Wednesday, during an opening day session of the 2021 Annual Meeting of the National Association for Behavioral Healthcare (NABH), held in Washington, D.C.

Insel — who is a psychiatrist and neuroscientist by training — is the co-founder and president of the digital mental wellness platform Mindstrong Health, a Mountain View, California-based company that, to date, has raised $160 million in funding, according to fundraising tracking site Crunchbase.

“If I told you that same story [about treatment] for cancer, or heart disease, diabetes …, it’s hard to explain why more people getting more treatments … leaves you with more death and disability,” Insel said during the session.

Insel talked of how behavioral health in America was already at a serious point before the pandemic hit. COVID has further intensified struggles many were dealing with regarding stress, anxiety, depression and SUD.

While there has been more awareness on the issue of stigma with receiving behavioral assistance, he said that it only goes so far.

“I think we’ve actually tried to deal with … these issues, particularly [with] anti-stigma campaigns,” he said. “But as far as I can see, they’ve had … no impact on morbidity and mortality.”

Insel said that in some respects, the nation’s behavioral health system has regressed from when he first started professionally in the mid-1970s. Even as psychiatric facilities nationwide had been closing due to decades of mismanagement, he noted among other things that behavioral patients were not housed in correctional facilities like many are today.

Additionally, he believes that there was more of an expectation of accountability in those days to deliver quality care, even if expectations were not always met.

“In 1975, if you were a doctor with a patient, you were accountable,” he said. “It didn’t matter whether they were in the state hospital, went back to school, [or] went home, wherever they went, they were yours… . We can be accountable, but we don’t do that these days.”

Insel feels improved social engagement with patients can drive better outcomes for behavioral health. Better engagement, he said, can come from more providers using evidenced-based practices that have proven to be effective. 

Insel believes that the private sector can also play a role, particularly companies coming out of Silicon Valley with new technologies that help engage patients on their wellness journey.  

Despite recent controversies of apps like Facebook and Instagram concerning youth mental health, Insel said that many tech-driven companies are able to positively engage users, particularly those with behavioral issues. 

“I think this is the place where technology can really make a difference,” he said. “We have a lot to learn from how that world has figured out how to get people to [a point of] social engagement, [which are] all the things that we don’t do very well.”