Conventional approaches to treating mental-health conditions are failing us.
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We are currently in a worldwide mental-health crisis. In the United States alone, nine out of ten deaths are caused in part by stress – and youth are particularly at risk. Almost a fifth of youth report having serious suicidal thoughts and almost ten per cent have attempted suicide.
This autumn, Congress allocated much-needed funds to support new and existing crisis and suicide services as well as community behavioural-health clinics. These infusions of cash, though, while desperately needed, will not easily solve the problem: mental-health-care workers are stretched thin and our current go-to mental-health treatments are not scalable. Many people lack access to high-quality care, and widely available, personalised health care sounds great but doesn’t yet exist.
What’s more, the long-standing focus on symptom reduction in the US has proven inadequate. What’s needed is a new approach to mental-health care: one that goes beyond treating disorders or even anticipating them – that is, preventative medicine – but rather enables a higher level of psychosocial functioning, also called resilience. An integrated data platform that includes not only regular monitoring of patient biological data and symptomology but also social data can help us intervene earlier to improve resilience across society.
Within our current mental-health-care system, delayed diagnosis and treatment are particularly prevalent – and problematic. A majority of mental-health conditions first develop early in life (almost 50 per cent by age 14 and 75 per cent by age 24), and more than a decade can elapse between when symptoms first appear and an intervention takes place. Failure to treat symptoms during these formative years puts youth at high risk of chronic, sometimes disabling conditions. A community resilience-based approach begins in schools to ensure youths have the tools to navigate adversity.
Another enormous issue is inadequately treated serious mental illness, which puts enormous strain on the health-care system. In San Francisco, two-thirds of people hospitalised for a serious mental illness end up back in the psychiatric-emergency room. In fact, just five individuals were responsible for 1,781 ambulance transports over the last five years, to the tune of $4 million. These individuals are not failing us; we are failing them. What’s more, these mental-health conditions disproportionately impact communities of colour which also take longer to recover, making this a health-equity issue. Building community-wide resilience will help ensure fewer end up in urgent care – and, when they do, they will be less likely to return.
An integrated data platform can help us move beyond treating symptoms towards building resilience.
Tech has enabled the collection and analysis of vast troves of data which can be combined to provide a comprehensive – and predictive – picture of a person’s wellbeing. These data include self-reported symptoms, results from cognitive tests, genetic information, lab results, information on life experiences and brain physiology.
Further innovations have dramatically expanded the scope of the data that can be gathered outside the lab or clinic. Wearables can measure heart rate, body temperature and sleep patterns – and soon brain physiology and hormone levels. New at-home devices can analyse a dried blood spot and upload the results immediately to the cloud. Cognitive assessments, symptomology and life history can be collected using apps as well.
In isolation, patient data are very useful – for example, screening positive on an inexpensive Adverse Childhood Experiences questionnaire indicates whether a patient is at risk of developing chronic conditions or is likely to respond to one medication over another. Put together, these heterogenous data sets can paint a powerfully precise picture of someone’s mental health, which can help inform personalised treatment plans and ultimately lead to better treatment, sooner.
To fully realise the potential of these innovations, we will need an integrated data platform which can house a wide variety of data – from cognitive assessments, wearables, patient surveys and labs. It must be interoperable with existing electronic health-record-management services and other platforms to enable collaborative, comprehensive care, quickly. The data must be gathered early and often – before a mental-health concern rises to the level of crisis. Practically, this means incorporating resilience-building tech into schools and families. Eventually, diagnostics should occur in real-time. Finally, sometimes our family and friends know us better than we know ourselves. An option for 360-degree assessments could create an even clearer picture of an individual’s wellbeing.
Interdisciplinary centres like the upcoming California Stress and Resilience Institute can guide our understanding on how best to foster resilience and can spearhead continuing education programmes to ensure clinicians can leverage innovative tech to build resilience. Payers must incentivise these holistic assessments and other resilience-building tools that pay dividends – for every $1 spent treating mental-health conditions, there is a $4 return in better overall health and productivity (the cost savings would arguably be greater if conditions are addressed before they even begin). While gathering and analysing patient data is incredibly important for researchers to develop new insights, patient privacy must be protected.
The key to a thriving society is ensuring individuals can adjust to adverse circumstances. Like an internal pendulum that allows a skyscraper to gently sway during a tremendous earthquake, a resilience-building data platform is tech to help even the most vulnerable among us weather the storm.