The National Institute of Mental Health has funded 109 new research grants so far this year. By this point last year it had funded 900. That gap is not just a budget story. It is a window into something Tom Insel has spent 13 years at the top of the field, and a decade since, trying to understand: why the science keeps advancing while the outcomes for patients barely move.

In this episode of Neural Compass with Mark Jacobstein, we look at what it actually takes to move the needle on mental health outcomes and why $14 billion in investment and decades of research haven't done it yet.

Mark speaks with Dr. Thomas Insel, who served as director of the National Institute of Mental Health for 13 years and oversaw over $20 billion in research funding. Tom's work spans the neuroscience of social behavior, the politics of psychiatric research, and five startups built on the conviction that the system needs to be rebuilt around outcomes, not access. His book Healing examined why the mental health crisis persists despite our best efforts.

They explore the growing gap between research investment and patient outcomes, what the decline in new NIMH grants signals for the next decade of treatment, why AI may do for mental health what DNA sequencing did for cancer, and what it took personally and professionally to leave the institution he led and start over.

Neural Compass is a podcast from Jimini Health, which builds clinically embedded AI for behavioral health.

If you found this conversation valuable, please leave a rating or review on Apple Podcasts.

About the Guest: 

Dr. Thomas Insel is a psychiatrist, neuroscientist, and entrepreneur who served as the Director of the National Institute of Mental Health (NIMH) for over thirteen years. After leaving the NIMH in 2015, he joined Alphabet (formerly Google) at Verily before launching several startups focused on mental health, including Mind Strong, Vanna Health, and Benchmark Health. He currently serves as an advisor to the venture capital group Grey Matter and is the author of the book Healing.

[00:03:00] The Evolution of Social Neuroscience 

Dr. Thomas Insel describes his early work on the neural basis of complex social behaviors such as attachment and parental care. He explains that this research was initially considered taboo by neuroscientists who preferred studying motor or sensory pathways. This persistence eventually led to a better understanding of the role of oxytocin and other peptides in social bonding.

[00:15:00] Defining the Role of the NIMH 

The discussion clarifies that the National Institute of Mental Health shifted in 1992 to focus exclusively on research rather than direct services. Dr. Insel defends the importance of funding basic science that might not yield results for decades. He notes that while immediate service needs are urgent, basic research is essential for developing the next generation of therapeutics.

[00:20:00] Addressing the Funding Crisis in Science 

Dr. Insel highlights a concerning drop in the number of new grants funded by the NIMH compared to previous years. He argues that gutting the agencies responsible for discovery is a shortsighted strategy for the nation. This lack of investment threatens the vibrant ecosystem that typically turns great science into life-changing technology.

[00:26:00] Navigating the Dysfunctional Healthcare Marketplace 

The conversation explores the challenges of building a successful health tech business when multiple stakeholders have conflicting incentives. Dr. Insel admits that even with his background, learning the perspectives of the payer, provider, and patient was a difficult process. He emphasizes that innovations must either save lives or save money to gain adoption in the current system.

[00:30:00] Implementing the Advocacy Model for Serious Mental Illness 

Through his work with Benchmark Health, Dr. Insel introduces the role of the "Advocate" to help patients navigate the complex mental health system. This role provides a consistent Sherpa for the patient journey and focuses on achieving high-quality outcomes. The model has already shown success by improving patient satisfaction and reducing costs for Medicaid payers.

[00:41:00] AI as the DNA of Mental Health Diagnostics 

Dr. Insel predicts that AI will transform psychiatry in the same way that DNA sequencing transformed oncology. He suggests that machine learning will finally provide the objective data needed for measurement-based care by tracking behavior and cognition over time. This shift toward personalized psychiatry will rely on digital biomarkers rather than just traditional clinical interviews.