The National Academy of Medicine’s (NAM) 2025 Vital Directions for Health and Health Care explores radical change,1 especially what we must do at the political level,2 that has powerful implications for mental health and medical education in mental disorders.
Formerly the Institute of Medicine, the NAM is an independent, nonprofit organization that provides nonpartisan, evidence-based leadership to advance science, inform policy, and catalyze action to achieve optimal health for all.
The NAM makes explicit the threat to health care posed by the medical industrial complex (MIC) of hospitals, insurance companies, pharmaceutical houses, and equipment manufacturers. They have largely displaced physicians and medicine in guiding health care and now have much control of its direction. But they are profit-driven, wedded to the status quo, eschew prevention, and ignore costs.
Requiring congressional and executive approval, the NAM advised that a federal agency analogous to the Federal Reserve in its independence and authority oversee all health care. A “Health System Accountability Board” will have the authority and responsibility for ensuring cost-effective care with full access to quality, safe care for all Americans. It will have oversight capacity and the mandate to punish health care entities that fail to meet guidelines. To guarantee its independence, there will be an odd number of members appointed by the president in staggered terms (to avoid the potential of executive control), and members will require Senate confirmation. The Board’s authority will include viewing all financial reports of health care organizations, and its members will not be able to own stock in health care entities.
Monitored and enforced by the Board, Congress will also enact an equitable balance between the benefits nonprofit hospitals receive and the resources they provide to the community. And tax-exempt status will require hospitals to participate in public health programs associated with improved outcomes, as well as the provision of meaningful financial support for people below the 400 percent poverty level. A congressional mandate will prohibit health equity firms from controlling care delivery organizations.
The new Board will establish these principles: equal access for all to quality, safe care; the centrality of primary care; payment for care of populations (rather than fee-for-service); incorporating the social determinants of health; administrative efficiency and reduction of health care expenditures; organizational professionalism and ethical mandates; and data-driven decision making.
Mental health care will benefit the most because it’s now the poor country cousin of U.S. health care regarding access, quality, and safety of care.
I recently had the honor of being invited to the NAM’s Board on Health Care Services to express my ideas for reversing medicine’s near dismissal of mental illnesses. I emphasized that the basic prerequisite will be replacing the mind-body split theory that now guides patient care, teaching, and research; especially devastating for mental health care is the theory’s isolated interest in physical diseases. While its shortcomings have long been recognized by many, why has this theory persisted? Medicine, including its present leaders, has been “brainwashed” during seven or more years of medical training in the mind-body duality. I emphasized that no major changes can occur without jettisoning the worn-out theory we perpetuate through medical education. Radically revising medical education is the starting point for replacing the mind-body split theory with the modern systems view of science held by all other sciences.
Medical students, residents, and fellows of the future will be trained in the same systems-based science. Operationalized by evidence-based patient-centered interviewing practices, the systems-based biopsychosocial model would replace the mind-body duality as medicine’s guiding theory.
Theory guides actions—recognized or not. The NAM has provided a template for finally recognizing this.
I provide greater detail on how to correct the mental health problem in my book Has Medicine Lost Its Mind?3
link
