California Governor Gavin Newsom has appointed the former director of the National Institute of Mental Health (NIMH), Tom Insel, MD, to be his principal adviser on mental health and to reorganize the state’s mental health delivery system. The governor said Insel will volunteer his time for this role. Most recently Insel has been president of the mental health technology company Mindstrong Health, based in Mountain View, California.

Newsom announced Insel’s appointment as “mental health czar” at a May 21 press conference in Oakland on California’s homeslessness crisis. He said the physician will work with state Health and Human Services Secretary Mark Ghaly, MD, MPH, to reorganize the state’s mental health delivery system. Insel “will inform the state’s work as California builds the mental health system of tomorrow, serving people whether they are living in the community, on the streets or if they are in jails, schools or shelters,” said a press release from the governor’s office.

Newsom also announced the formation of the Homeless and Supportive Housing Advisory Task Force and appointed Sacramento Mayor Darrell Steinberg and Los Angeles County Supervisor Mark Ridley-Thomas as co-chairs.

Before the appointment, Insel hinted at his likely priorities at a CALmatters panel discussion in Sacramento. He pointed to a lack of leadership and the difficulty of coordinating programs in 58 counties as two major reasons for California’s fragmented mental health system. “It’s like trying to play the piano with 58 fingers,” he said.

In April, Insel and coauthor Seth A. Seabury, PhD, associate professor at the University of Southern California’s School of Pharmacy and the Leonard D. Schaeffer Center for Health Policy & Economics, wrote a CALmatters commentary that emphasized the importance of educational attainment in helping people with mental illness. “Interventions that identify and treat young adults who are first starting to struggle with serious mental illness, and that support their continuation in school and successful graduation, are a true bargain,” they wrote.

A Deep Résumé

Insel brings decades of experience to his new job. After earning undergraduate and medical degrees from Boston University, he trained in psychiatry at the University of California, San Francisco. He pursued a research career at NIMH, Emory University, and the Center for Behavioral Neuroscience before becoming NIMH director in 2002.

Throughout his tenure at NIMH, “Insel explicitly defined mental disorders as brain disorders,” David Dobbs wrote two years ago in the Atlantic. Critics argued that this approach dismissed the influence of the environment and social relationships in determining mental health. But Insel and his supporters said he successfully pushed NIMH to devote “more research to the most serious mental disorders, such as major depression, schizophrenia, and bipolar disorder.”

Insel stepped down in 2015 after 13 years as director. “The NIMH has accomplished so much during this past decade — progress in neuroscience, progress in diagnostics and therapeutics, and, most of all, progress toward a focus on the needs of people with serious mental illness,” he wrote in a farewell letter on the NIMH website.

He then came to California to lead a mental health program at Verily, a subsidiary of Google parent company Alphabet Inc. The offer from Verily was “intriguing and, frankly, a bit disruptive,” Insel told the Washington Post. “What was really the offer I couldn’t refuse was the possibility that a big tech company like Alphabet would want to do something in [mental health].”

There’s an App for That

By the time Insel left Verily in 2017, the company had developed the initial parts of its mental health products but hadn’t released any, Sara Reardon reported in Nature. Nonetheless, Insel told Reardon, “I felt like Verily was at a point where it was big enough and successful enough [that] I could walk away. I knew in moving to Verily it would be a transitional job until I could figure out what I really wanted to do, and I’ve had an entrepreneurial itch.”

That took him to the start-up Mindstrong, where he joined founders Paul Dagum, MD, PhD, and Rick Klausner, MD. Dobb wrote in the Atlantic that “Mindstrong’s plan, much like that of Insel’s unit at Verily, is to use the smartphone’s powers to do two things that psychiatry hasn’t figured out how to do: easily detect early, or even predict, the onset of mental illness; and quickly get effective, affordable care to those who need it.”

The Mindstrong smartphone app collects “measures of people’s cognition and emotional health as indicated by how they use their phone,” MIT Technology Review’s Rachel Metz wrote. “The seemingly mundane minutiae of how you interact with your phone offers surprisingly important clues to your mental health, according to Mindstrong’s research — revealing, for example, a relapse of depression.”

In October 2018, Mindstrong was on “the cusp of a real-world deployment in California,” wrote STAT’s Kate Sheridan. That deployment was facilitated by California’s Mental Health Services Oversight and Accountability Commission, which selected two apps, including Mindstrong’s, to roll out to selected target populations. “Even before the app launched in the original five counties that had signed on, the pilot had expanded,” Sheridan wrote. “Another 11 counties have recently decided to join.”

University of California, Irvine, was selected to conduct the evaluation, which has not yet been published.

A Mindstrong spokesperson said Insel will continue working with the company while he serves the Newsom administration, Sheridan reported.

Helping Struggling Students

Insel’s CALmatters commentary suggests that in his government work he may focus on helping struggling students stay in school, ensuring that people with mental illness get treatment, and bolstering the state’s mental health workforce. “By spending more now to expand the behavioral health system’s capacity, including the hiring and training of additional providers, we may be able to spot mental disorders early and give patients the opportunity that all Americans deserve: an education that can serve them for a lifetime,” Insel and Seabury wrote.

At the CALmatters briefing, Insel expressed optimism about the state mental health system’s future. “I’m actually hopeful that this is doable if we as a society, as a state, decide we want to make [mental health] a priority,” he said. “We can do it better than anyone’s ever done it.”

Now California has the chance to prove it.

Xenia Shih Bion

Xenia Shih Bion is a communications officer at CHCF, where she helps to lead communications around the foundation’s work to create health equity. She is the founding author of the “Essential Coverage” column in The CHCF Blog. Read More

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