NIMH · Atonement

In his blog post entitled AtonementThomas Insel, MD, Director of the National Institute of Mental Health (NIMH), calls for humility:

So this year on Mental Illness Awareness Week, my call is for humility. We need to be aware that mental disorders are immensely complex—too complex for scientists, clinicians, patients, or families to solve alone. Prevention, recovery, and cure—the NIMH vision—need a collective effort. Beyond the day—or week—of atonement, we need a massive campaign to transform diagnosis and treatment.

http://www.nimh.nih.gov/about/director/2014/atonement.shtml

Below I directly quote his very moving and thoughtful piece in its entirety.

Thank you, Dr. Insel.


Director’s Blog: NIMH · Atonement
By Thomas Insel on October 8, 2014

One of my first meetings when I arrived at NIMH 12 years ago was with board members of the National Alliance on Mental Illness (NAMI). I asked them how NIMH could be helpful. One board member’s request was especially memorable. “Declare a day of atonement,” she suggested. When I saw this same board member last month at the annual NAMI meeting, we both recalled that 2002 meeting with a touch of regret. I wished I had had a better response to her request. And, as she said to me last month, “I wished I had asked for a week.”

As it turns out, Mental Illness Awareness Week this year began with Yom Kippur, the Jewish Day of Atonement. Which begs the question: what do we (in the mental health community) need to atone for? There are so many answers. For some, it may be the culture of blame and shame perpetuated for years by clinicians who explained all mental illness as being caused by trauma and evil parents. For others, it may be the singular reliance on medication and modifying behavior rather than holistic care and the provision of skills. Others will name the paternalistic structure of mental health care, which can undermine rather than empower individuals and their families. The list goes on. Maybe it would take a week, not just a day, to capture the many complaints.

My own favorite atonement issue for Mental Illness Awareness Week this year is the lack of humility in our field. Mental disorders are among the most complex problems in medicine, with challenges at every level from neurons to neighborhoods. Yet, we know so little about mechanisms at each level. Too often, we have been guided more by religion than science. That is, so much of mental health care is based on faith and intuition, not science and evidence. On the plus side, we put a premium on listening and compassion. We help people to change through understanding. But not enough of our care has been standardized to a high level of quality, as expected in the rest of medicine.

On the research side, it’s easy to lose humility. The pace of discovery in genomics and neuroscience is ever more rapid—this week’s Nobel Prize in Physiology or Medicine is a good example of how neuroscience is revealing the fundamentals of brain activity—in this case describing the brain’s “GPS” network. Advances in systems neuroscience, from dissecting circuits to human brain imaging, are unequivocally stunning. But, and this is a humbling caveat, we simply have not been able to translate this revolution in neuroscience to diagnostics or therapeutics for people with mental disorders.

Why the disconnect? Translation takes time. Translation requires replication, regulation, and ultimately reimbursement. Fundamentally, translation is really difficult. For instance, we have thousands of neuroimaging studies but none that has delivered a clinically useful biomarker. For NIMH this is a humbling realization—we still lack biomarkers to identify who should get which treatment. We still lack effective treatments for many aspects of mental illness.

So this year on Mental Illness Awareness Week, my call is for humility. We need to be aware that mental disorders are immensely complex—too complex for scientists, clinicians, patients, or families to solve alone. Prevention, recovery, and cure—the NIMH vision—need a collective effort. Beyond the day—or week—of atonement, we need a massive campaign to transform diagnosis and treatment.

http://www.nimh.nih.gov/about/director/2014/atonement.shtml

Mental Health Resources

RESOURCES IN THE UNITED STATES
Descriptions are directly quoted from each resource’s website.

DBSA: Depression and Bipolar Support Alliance
dbsalliance.org

Support Groups Help
Depression and bipolar disorder can be isolating illnesses, but DBSA support groups can help you connect with others who have been there as well. Visit a DBSA support group and get the support that is essential to recovery.

IBPF: International Bipolar Foundation
ibpf.org

The mission of International Bipolar Foundation is to improve understanding and treatment of bipolar disorder through research; to promote care and support resources for individuals and caregivers; and to erase stigma through education.

MentalHealth.gov

MentalHealth.gov provides one-stop access to U.S. government mental health and mental health problems information. MentalHealth.gov aims to educate and guide:

  • The general public
  • Health and emergency preparedness professionals
  • Policy makers
  • Government and business leaders
  • School systems
  • Local communities

Mental Health America
mentalhealthamerica.net

Mental Health America, founded in 1909, is the nation’s leading community-based network dedicated to helping all Americans achieve wellness by living mentally healthier lives.

NAMI: National Alliance on Mental Illness
nami.org

NAMI is the National Alliance on Mental Illness, the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raise awareness and build a community for hope for all of those in need.

NAMI FaithNet
faithnet.nami.org

NAMI FaithNet is a network of NAMI members and friends dedicated to promoting caring faith communities and promoting the role of faith in recovery for individuals and families affected by mental illness.

National Suicide Prevention Lifeline
suicidepreventionlifeline.org
1-800-273-TALK (8255)  ~  Call 24/7

The National Suicide Prevention Lifeline is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. By dialing 1-800-273-TALK (8255), the call is routed to the nearest crisis center in our national network of more than 150 crisis centers. The Lifeline’s national network of local crisis centers provide crisis counseling and mental health referrals day and night.

NIMH: National Institute of Mental Health
nimh.nih.gov

The mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.

Substance Abuse and Mental Health Services Administration
samhsa.gov

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Veterans Crisis Line
veteranscrisisline.net

VeteransCrisisLineLogo
1-800-273-8255 press 1
Text to 838255
Confidential Veterans Live Chat available online