Imagine we had a cure for mental illness. Today. Right Now. Imagine we had a pill, a “magic bullet,” that, if taken on a daily basis, would eliminate the voices, delusions and cognitive difficulties of schizophrenia, the mood swings and psychosis of bipolar disorder and the grinding depths of depression. What would that world look like? How would things change? Would it be the ultimate day, so longed and hoped for? The end of millennia of suffering? Maybe. Maybe not.
In the July 11, 2014 issue of Psychiatric Times, Dr. Thomas R Insel MD, Director of the National Institute of Mental Health (NIMH,) address this hypothetical issue and draws some salient, if disturbing conclusions. Insel compares the situation of a potential cure for mental illness to that of the current situation with HIV/AIDS treatment. Recent advances, primarily in Antiretroviral Therapy (ART), have changed AIDS from a certain death sentence to a treatable chronic illness with a near-normal life expectancy. Despite this, however, fully 75% of persons infected with the HIV virus do not have complete access to treatment. They either do not participate in care, get partially treated or drop out of treatment for various reasons: side effects, cost, they don’t feel “sick” anymore.
I began training as an internist and discovered that this 75% phenomenon is not limited to HIV. It's the same for high blood pressure medications, antibiotics and pretty much any treatment for any chronic illness. Insel believes, and I do as well, that a “cure” for mental illness will face this same 75% barrier.
The same persons who don’t think they are mentally ill to begin with, still won’t think they are mentally ill. We have good treatments now, and many patients don’t want it. I don’t believe a “magic bullet” would change this. A good proportion of people would complain of side effects. The new drug – guaranteed – would be very expensive. And once a mentally ill person feels well, they will do what many people do: stop taking their medications.
What does this mean? I think it means that regardless of any scientific breakthroughs looming on the horizon, the treatment for mental illness tomorrow, will look pretty much like it does today. Mentally ill persons will still need a coordinated team of professionals to deliver adequate care. We will still need psychiatrists, psychologists, social workers, financial assistance programs, outreach teams and crisis intervention. There will still be sticky court cases regarding “forced” treatment. Psychiatric hospitals, outpatient offices and emergency rooms will still be there.
Whether this is good news or bad depends upon your perspective. But I think it allows the scientific inquiry into mental illness to proceed full speed without a diminution in the role for the other members of a patient’s treatment team. It appears that as long as human beings with a chronic illness continue to act like human beings, we will see things in the mental health field continue pretty much as they are.
Unless, of course, a vaccine is developed that prevents mental illness entirely. But that’s a topic for another day.