Thomas R. Insel has served as the director of the National Institute of Mental Health (NIMH) since 2002, gaining respect as a leader who supports research that will help us understand, treat and even prevent mental disorders. During his tenure, major breakthroughs have been made in the areas of practical clinical trials, autism research and the role of genetics in mental illnesses.
He recently shared his views on a variety of issues presented to him by Frank Burtnett, editor of ACAeNews for Mental Health, Community Agency and Private Practice Counselors.
1) What do the American Counseling Association and its 55,000 members need to do to increase NIMH’s recognition and support of licensed professional counselors?
The National Institute of Mental Health is the federal agency investing in research on mental disorders. While our name suggests a primary interest in mental health, our mission is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure.
I hope ACA members will be interested in the new NIMH Strategic Plan for Research to be released in March 2015. This plan focuses on strengthening the public health impact of NIMH-supported research. One of the keys to increasing impact is providing rigorous scientific information that is useful to patients and providers by responding to their specific needs.
2) Anxiety and depression are the two diagnoses licensed professional counselors, like all mental health providers, deal with most often. What current and future research efforts will we see from the NIMH on these two fronts?
One of the insights from research funded over the past decade is the inadequacy of current diagnostic categories. While the current classification has been useful for providing a common language, it has not given us categories that appear valid in terms of causal mechanisms or treatment response.
NIMH’s Research Domain Criteria, or RDoC, project attempts to bring the power of modern biology, cognitive science and sociocultural perspectives to the problems of mental illness, studied independently from the classification systems by which patients are currently grouped. While RDoC, for now, is a research framework, not a clinical tool, NIMH is already recommending that we shift our language away from some of the currently used labels. As one example, depression — which is now treated as a single category — may turn out to be many disorders with different mechanisms, requiring different treatments.
In addition to transforming diagnostics, NIMH is looking at a new generation of treatments. The advent of new devices, mHealth (mobile health), cognitive training and social media will likely change the landscape of mental health care.
I’d suggest two trends to watch. One is the empowerment of patients who will demand clinical excellence and will be sharing their experience on social media. The second is the need for our field to move beyond magic bullets, whether those bullets are medicines or psychotherapies. We need to help patients find network solutions – solutions that may be tailored more to their needs than to our skills. For most people with mental disorders, recovery will depend on a mix or a network of interventions, not a single modality of care or even a single provider.
3) Licensed professional counselors are positioned to improve public access to mental health treatment in the future. What can we do to galvanize our role in ensuring that access?
Improving access is certainly important, but even more important is improving quality of care. While access has increased over the past two decades, we have not seen associated decreases in morbidity or mortality (suicides) from mental illness. The reason for this disconnect is probably complex, but one possibility is that quality of care has not been held to the same standards in our field as we expect for cardiovascular surgery or renal dialysis.
Recent legislation mandates parity for mental health and physical health treatments, but do we have parity for the standards of quality? NIMH has supported an Institute of Medicine study of how to ensure the quality of psychosocial treatments. You should watch for this report, due by April 2015, which I expect will suggest some quality metrics that can be used to ensure that licensed professional counselors are delivering the same treatments that have been shown to be effective in rigorous clinical trials.
4) ACA members, a significant number of whom are clinicians in agencies, hospitals and private practice, appreciate your support in giving professional counseling a place at the policy generation and analysis table. What has ACAeNews for Mental Health, Community Agency and Private Practice Counselors not asked you that you want our members to know?
One of the themes mentioned by President Obama in his State of the Union address was precision medicine. Precision medicine means getting the right treatment at the right time to the right person. As pointed out on the National Institutes of Health website, while significant advances in precision medicine have been made for select cancers, the practice is not currently in use for most disorders. What does precision medicine mean for mental health?
Our version is the RDoC project, mentioned above, which aims to develop more precise diagnostic categories based on biological, psychological and sociocultural variables. RDoC assumes that we will need many kinds of data to reach precision, much like triangulating to find one’s position on a map. These data will draw from many sources, including symptoms, genotype, physiology, cognitive assessment, family dynamics, environmental exposures and cultural background. Watch for the RDoC Discussion Forum, a soon-to-be-launched online platform where investigators and clinicians can converse and collaborate with each other around the RDoC framework in a virtual environment.
This interview appeared originally in the March 2015 edition of ACAeNews for Mental Health, Community Agency and Private Practice Counselors.