Newsletter 3

Dear (name),
It was so gratifying to hear from so many of you after my last newsletter. Keep the lines open, I love to hear what is going on with you. For the many who asked, I’m grateful that my son, Jim, is doing well and back to playing tennis following his cardiac arrest and quadruple bypass in early October. Thanks for your support, it meant a lot to me.

Great News! My agent, Regina Ryan, identified a publisher for my book: Prometheus Books. They will publish Has Medicine Lost Its Mind? in hardcover (and e-book) as a lead title of their Spring 2025 season. Prometheus Books is the type of publisher for whom I was hoping. Their focus is “intelligent nonfiction for the thoughtful lay reader” with goals of “testing the boundaries of established thought and providing readers with thoughtful and authoritative books…” This sums up what Has Medicine Lost Its Mind? seeks to do: serve as a catalyst for change in the way medicine addresses mental health care.

A novel approach to mental health care screams for recognition. This is perhaps most apparent in those with a “serious mental illness (SMI).” Here is the cruel irony: well-known, effective treatments exist, but most SMI patients do not receive them. To better understand patients with SMI, two books provide excellent insights: Insane Consequences—How the Mental Health Industry Fails the Mentally Ill by DJ Jaffe (Prometheus Books, 2017) and Healing—Our Path from Mental Illness to Mental Health by Thomas Insel (Penguin Press, 2022).

Of over 50 million people in the US with a significant mental disorder, about 20 percent have a SMI. The remainder are of course significant but lack the psychotic features that characterize SMI patients with schizophrenia, severe bipolar disorder, and severe depression; some with borderline personality disorder and severe eating disorders may also be classified as SMI.

Here are some sad statistics. Of the SMI population of 10 million or so, 140,000 are homeless, 400,000 are in jails or prison, and nearly 800,000 are on probation or parole. This abject failure of our health care system led Dr. Insel, the former Director of the National Institute of Mental Health, to label current SMI care as a “human rights” problem. These patients need health care, not incarceration or helplessly fending for themselves on the streets.

The health care system has failed these unfortunate people. The lack of frontline mental health care expertise to identify patients early and the severe shortage of mental health professionals to provide treatment are only part of the problem. Often difficult to manage, necessary long-term support and a safety net are rarely available. Specialized inpatient facilities are in short supply as are credible long-term outpatient services. Rather than providing ongoing treatment, the system has provided only erratic crisis management. Then we have the shocking data that SMI patients die 15 to 30 years earlier than other people, mostly of unattended medical diseases.

Surprisingly, medicine does not seem embarrassed and has done little to rectify the problem. And the need is not more research or some innovative discoveries. Rather, we need to better execute what we already have and know. Has Medicine Lost Its Mind? aims to prompt change in a health care system that lets patients with mental illnesses fall by the wayside. Your ideas about what to do are most welcome. There’s no pat answer.

Thanks for following and please suggest to your friends that they go to my website (below) and sign-up.

Take care.

Bob

Robert C. Smith, MD, MACP

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