Post by Former NIMH Director Thomas Insel: The Ignorance Project
Attending the World Economic Forum this past week, I was struck by two trends. The first was that brain research has emerged as a hot topic. Not only was brain science or brain health a new theme at the meeting, research on the brain emerged in discussions about next generation computing, global cooperation, and even models of economic development as well as being linked to mental health or mindfulness. In a meeting frequented largely by economists and business leaders, I was surprised by the number of non-scientists who have become enchanted by brain science. Clearly this is the era of the brain, with mental health now part of a much broader discussion.
The second trend was, for me, more surprising. On the first evening of the Forum, about 50 of the presenters gathered for an “experts” reception to hear Hans Rosling, a professor of global health from the Karolinska Institute in Stockholm, speak about the state of the world. Instead of giving a lecture, Hans gave a multiple-choice quiz about vaccination rates, changes in poverty, population distribution, education levels for girls, and several other indicators. In five minutes, you can take this quiz yourself or check out the Ignorance Project at www.gapminder.org. Be warned that the Davos “experts” failed miserably on virtually every question. We didn’t just fail, we were worse than chance, meaning that we had consistent misconceptions about these critical statistics. In every case, we thought the world was far worse off than the statistics indicate. Enough said, take the test. Perhaps you will do better, but like nearly all groups who have taken the ignorance challenge, you may see an interesting pattern: we don’t know about progress. The Ignorance Project is, paradoxically, highlighting our ignorance about good news.
I suspect the combination of the 24-hour news cycle focused on the latest crisis and our cognitive bias to overvalue negative information explains much of the problem. We usually don’t hear about the slow but substantive successes and when we do hear about them they seem less tangible than the disparities and suffering which continue. And yet the importance of these successes must not be underestimated: they demonstrate that we can make progress on some of the world’s greatest problems, a point made at the Forum by Bill and Melinda Gates talking about population health and by Al Gore talking about climate. Our focus on the never-ending crisis of the moment breeds the sense of hopelessness and helplessness that can hijack our will to make a difference.
In one of my all-time favorite TED talks, Rosling argues that data can also counteract this ignorance. The Ignorance Project, led by his son Ola Rosling, aims to collect the critical statistics as a dashboard for many areas of population health. It will be equally important to do this for mental health. Of course, it may be more difficult to find substantial progress if we focus on rates of morbidity and mortality from mental disorders. The U.S. suicide numbers released last week show an (age-adjusted) rate of 12.57 per 100,000. That is 41,149 suicide deaths in 2013.1 Compared to 31,484 suicide deaths in 2003, this hardly looks like progress. The most recent measures of morbidity based on disability adjusted life years show no hint of progress between 1990 and 2010 for schizophrenia, depression, or anxiety disorders.2 The NIMH website has a statistics section which is a good start for looking at the latest data on prevalence and mortality.
But not all the news is negative.
Curiously, most of the positive trends in mental health are not in outcomes but in “inputs.” Check out the new Behavioral Health Barometer from the Substance Abuse and Mental Health Services Administration. The Barometer reports some positive trends: the number of people receiving treatment for a substance use problem has increased six percent from 2009 to 2013, and the percent of adults with serious mental illness who received treatment rose from 62.9 in 2012 to 68.5 in 2013. While we don’t yet have an Ignorance Project for mental health, we can begin to make sure the data—the good, the bad, and the ugly—are available. A quiz on these numbers and the trends in mental health over the past two decades may not leave us entirely optimistic, but we must not forget that there are signs of progress and reasons to be hopeful. As Hans and Ola Rosling are teaching us, ignorance is not bliss. It can breed a sense of helplessness that subverts progress and hope.
1 National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System, Fatal Injury Reports, National and Regional, 1999-2013. http://webappa.cdc.gov/sasweb/ncipc/mortrate10_us.html, accessed January 27, 2015.
2 US Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013 Aug 14;310(6):591-608. doi: 10.1001/jama.2013.13805.