In the United States, one in five adults experience mental illness in a given year. This represents an incredible amount of pain and suffering endured by millions.
A Massive, National Problem.
On average, one American dies every four minutes due to suicide or drug- or alcohol-induced causes. The impact of behavioral conditions is further pronounced when considering the effects on physical wellness. According to the CDC, U.S. adults living with serious mental illness die, on average, 25 years earlier than others — largely due to treatable medical conditions.
The economic burden adds to the human toll. For patients with chronic medical conditions, comorbid behavioral conditions result in medical spend that is 2–3 times as high. Including indirect effects such as lost productivity, depression alone costs our country over $200 billion, more than three times the budget of the U.S. Department of Education.
Help for individuals experiencing Behavioral Health (BH) conditions is constrained by limited resources and a fragmented support system. This lack of integration hinders effective treatment, further straining the existing network of care.
At Providence St. Joseph Health (PSJH), we feel that it is our duty to continuously seek ways to better support the mental health needs of those we serve. In conjunction with clinical and operational efforts being undertaken across the system, we have a great opportunity to apply digital tools to reduce the human suffering and the avoidable burden experienced by our communities and caregivers.
In this effort, we acknowledge the meaningful obstacles inherent to BH care that are responsible for these outcomes. These challenges, which exist in other clinical areas but are especially pronounced in BH, include the stigma associated with conditions (which hampers diagnosis and treatment), limited resources in funding and personnel, and the dependency of wellness on a complex combination of clinical and non-clinical factors. Successful treatment relies on coordination among a particularly diverse multi-disciplinary team, and requires tracking complex and time-varying measurements like “mood,” which can’t be observed with a clear blood test. Combined with the motivational and cognitive challenges mental health patients experience, it’s no wonder that maintaining mental and emotional wellbeing is a national struggle.
Fortunately, many of these challenges are well-suited to the capabilities technology provides. Digital solutions can offer privacy, even anonymity, to mitigate the effect of the pervasive stigma. They can measure subtle behavioral changes over time, screening for conditions and guiding effective treatment in ways that point-in-time tests cannot. The use of digital tools to augment human efforts in other industries by coordinating information and activities across large groups suggests the potential to do the same here.
In addition to their relevance to the challenges in BH, digital tools are especially applicable due to their ability to deliver diagnosis and treatment, a function in which they are much more constrained for medical and surgical episodes.
The Digital Potential.
From a systems perspective, a primary challenge in BH care boils down to a distribution of care problem. The entities involved in maintaining an individual’s wellbeing, including clinicians, community resources, families, and the individuals themselves, often lack the time, tools and information to do so effectively. Nor do these entities exist in a cohesive system in which entities support one another. This means that identification, prevention and care does not happen in the lowest possible acuity setting, as would be best both for patients and for an efficient healthcare system.
Instead, conditions develop unchecked and are only addressed once exacerbated, in the least convenient and costliest places like the Emergency Department or an inpatient unit.
Fixing this system requires empowering individuals, families, communities, and primary care providers (PCPs) with knowledge, information, and decision-making tools, and a supportive and coordinated system of care. Technology can support this transition, in a cost-effective and scalable way.
Digital tools can draw from an encyclopedic knowledge of best practices and patient information, and deliver the relevant information exactly when it is most useful. Solutions can analyze complex situations and alternatives, and help individuals translate knowledge into action with decision making tools and coaching-like guidance. With thoughtful design, technology can help coordinate information and activities across the myriad groups involved.
We are building towards a world in which individuals will, with consent, be automatically and confidentially screened for risk, receive self-management tools to build resilience and address low acuity conditions, and be connected to the right resource seamlessly — whether a therapist, housing assistance, or peer support, when needed.
PCPs will be empowered with more BH expertise to better partner with patients, their knowledge augmented by the latest body of clinical experience and seamless consults with psychologists and psychiatrists. An acute episode in the emergency department will be treated more efficiently by leveraging information from all previous encounters across other care settings. On discharge, patients will be integrated back into an informed and prepared support network of family members, community organizations, and their PCP.
Where To Start?
With a compelling vision for the future, the first task is to identify where to begin. Given PSJH’s position as a health system, and the role of the PCP as the primary patient advocate, we are first identifying tools to support the patient-PCP dyad. A multi-disciplinary team at PSJH is looking at tools to deliver digital educational content tailored to the patient, self-management resources like computerized cognitive behavioral therapy (CCBT) and mindfulness guidance, and virtual condition assessment, to provide more effective and convenient monitoring and treatment adjustment.
Once those capabilities are in place, we intend to expand the scope to envelop other settings and create a cohesive, patient-centered, digitally-enabled system of care. This would ensure efficient coordination with BH specialists (including through ongoing telehealth efforts), inpatient units, emergency departments, and our non-clinical community partners. There is also great promise in other functional areas, such as applying machine learning to passively screen patients for risk, and predictive analytics to more accurately identify the most effective treatment modality for an individual.
Although achieving this full vision may take several years, we’re particularly excited about the immediate opportunities for impact. Empowering patients and PCPs with digital tools that provide information and knowledge, decision-making capabilities, and improved coordination, will enable PSJH to expand the care we provide to our community members in need.