Post by Former NIMH Director Thomas Insel: May is for Meetings and Mental Health
*Dr. Insel was one of several innovative leaders invited to present at the 2014 National Council for Behavioral Health Conference.
This has been the week for mental health meetings, coinciding with the beginning of Mental Health Awareness Month. On Monday, the American Psychiatric Association meeting in New York City featured Vice President Biden. On Tuesday, the National Council for Behavioral Health (NCBH) conference in Washington, D.C., featured Hillary Clinton. On Wednesday, a forum organized by The Atlantic and NCBH brought together tech gurus for an eHealth Executive Summit for mental health. And Thursday was the beginning of the Society of Biological Psychiatry meeting featuring Patrick Kennedy.
While each of these meetings attracted a different audience, there were many shared themes. The changing ecosystem of mental health care is clearly both a challenge and an opportunity. With the implementation of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, more people will have insurance coverage and in principle be eligible for more care. But both speakers and attendees raised questions about who will provide that care and how that care will be reimbursed. As Medicaid becomes a bigger part of mental health care, how does that change the landscape of care? Do we have the workforce we need for the next decade? And how best to integrate mental health care with primary care?
Another theme was the emergence of technology. From wearable sensors to video game treatments, everyone seems to be looking to technology as the next wave of innovation for mental health care. At the eHealth Summit, start-up companies talked about integrating voice analysis, activity data, and even GPS tracking to identify changes in mood. New sensors are passive—capturing data on location, movement, and communication—portable, and precise, providing a continuous and more comprehensive picture of a person’s mental state. If sensors will transform detection and diagnosis, technology could have an even bigger role on therapies. Reports that online cognitive behavioral treatment can be as effective as in-person psychotherapy suggest that technology will expand access, extend the impact of a therapist, and expedite treatment for people who might not find “seeing” a therapist acceptable. For those with the most disabling disorders, high tech will need to be combined with “high touch”—online tools will extend rather than replace the therapist. But the promise of technology for improving treatments—online psychotherapy, video games for cognitive training, or social prosthetics for autism—certainly deserves attention, realizing that these are early days and that efficacy has been demonstrated for only a very few of the thousands of apps that are available.
For me, the third and most important theme from these meetings combined both the changing ecosystem and the emerging technologies. This is the possibility of engaging vast parts of the mental health care system, changing as it is, into a “learning” health care system. That is, collecting data as care is delivered to integrate practice into research and use the findings as feedback to improve care. Nearly every business collects metrics on inventory, sales, and workplace process. Health care has been slow to measure these kinds of outcomes. Increasingly, general medicine, via either managed care or large practice settings, is improving by collecting data through electronic records and refining practice based on what works.
Mental health care has been slower to adopt this kind of feedback for improving practice. This is where technology can help the field to catch up. Beyond electronic records, capture of the vast amounts of data from high tech sensors and therapies makes a learning mental health care system feasible on a grand scale. Of course, there are critical issues to resolve, from the need to integrate data across various platforms to concerns about data privacy. These are just the issues we should be discussing at the next wave of mental health meetings.
In the meantime, there are some important experiments to watch. The Mental Health Research Network, led by Dr. Greg Simon of Group Health in Seattle, integrates electronic records for 10 million patients across 11 health care systems to answer questions about suicide prevention and management of depression.1 The NIH Collaboratory, an even larger learning health care system co-led by NIMH, is seeking to transform the way clinical research is conducted through high impact pragmatic trials. The new Patient Powered Research Network, led by Andy Nierenberg of Massachusetts General Hospital, will create a cohort of 50,000 people with major depressive disorder or bipolar disorder to serve as a platform for mood disorder research. A national learning mental health care system has not been built, but imagine what such a system could do to identify best practices, track outcomes, and improve care. Welcome to Mental Health Awareness Month.
1 Insel T. Director’s blog: from practice to research. November 14, 2012. http://www.nimh.nih.gov/about/director/2012/from-practice-to-research.shtml .