Dr Insel: Challenging conventions of effective treatment

September 2016

This year at the annual Graeme Clark Oration, Dr Thomas R Insel asked those sitting in the audience to think beyond what we currently provide people with brain disorders.  

“Currently diagnosis is based on how you sound to me when I interview you, and then turning that into an objective science,” said Dr Insel. He is not disputing the essential nature of this form of diagnosis. But as far as ensuring correct diagnosis, early intervention and ensuring quality of care (factors we know that are often attributed to why the healthcare system fails those with brain disorders), Dr Insel believes patients need far more than what the system currently provides to lead functional and full lives.

If there is one person who knows mental health and brain disorders, including schizophrenia, depression, anxiety and bipolar disorder, it is Dr Insel. He was the Director of the US National Institute of Mental Health (NIMH) from 2002 – 2015 before recently moving to Verily, a branch of Google Life Sciences.

Convergence Science Network’s Graeme Clark Oration was held at MCEC on 30 August. Following the oration, Club Melbourne Ambassador Professor Patrick McGorry, Executive Director of Orygen, and Professor of Youth Mental Health at The University of Melbourne, hosted a thought provoking conversation at the Oration dinner. 

Dr Insel was at the NIMH through difficult years of declining funding, but admitted in an interview about his position at Google Life Sciences that is was never the budget that kept him up at night. It is the fact that the suicide rate has not gone down. A fact true in both the US and Australia, where the suicide rate has remained relatively unchanged in the past two years. 

During his time as Director at NIMH he launched a range of often controversial projects, including one that challenged the assumptions about the effectiveness of widely used antipsychotics. He also attempted to throw out the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders. It bothered Dr Insel that unlike conditions such as leukaemia or AIDS, brain disorder diagnosis is based on clusters of symptoms rather than “any objective laboratory measure” such as a biomarker or readout.

The estimated annual cost of mental illness in Australia at over $28B per year, 2.2% of the nation’s GDP. Dr Insel proposed that mental health disorders are the leading cause of disability. In addition to the poor functional outcomes and cost to the individual and the economy, these disorders are often fatal. Additionally, unlike cardiovascular disease and diabetes, brain disorders generally onset earlier in life take years to diagnose and then treat, and fatalities are too often in the younger members of our population. Knowing this, it made his statements at the oration all the more impactful, asking the audience to continue to challenge conventional wisdom of what constitutes effective treatment. 

In terms of suicide, Dr Innes highlighted that one in every 20 suicide attempts are successful. Of those, one in five had already made a previous attempt. Meaning the chance to intervene is high, but the systems currently in place too often fail. He posed the question – what if these people consented to being monitored via their smart phones? What if we had 24-hour support available digitally instead of them waiting for their next appointment? 

There are many challenges - privacy, data protection, consent, equity, access, integration and consistency of care.  Despite the fact that the emergence of the digitally empowered patient is disrupting the global healthcare delivery model across the therapeutic spectrum, clinicians will still need to clear the barrier of denial, mistrust, stigma and refusal of treatment that often prevents the mental health patient from taking the first step and accessing care. 

Club Melbourne is a proud sponsor of the Graeme Clark Oration and the Convergence Science Network.