We're all Stocked-up on Crazy: Part II

So where were we?

Oh yeah, the mental health system and all that’s wrong with it was what the last entry was about.

The New Era

But it has evolved in the recent years. There’s more awareness of the problem, the resources to handle the problem, the slight change in public opinion and support for treatment as opposed to casting those with such illnesses out of society, and the realization that there are functional people out there contributing to the economy and the communities despite (and at times because) they have mental illness.

Community Resources to Treat Mental Illness

There’s an increase in training and management of the issue by police and their collaboration with social workers and the broader healthcare community. There’s an increase in community resources to handle local problems proactively and respond with aid without having to fill the all- to-minimal supply of hospital beds in emergency departments and psychiatric wings closer.

More Clinicians, Support, and Technical Staff

These resources are now available in the communities where people live rather than in further away hospitals in major cities that can provide partial hospital-grade care through day or evening intensive programs through the use of professionals like specialized social workers, mental health counselors, nurse practitioners, and physician assistants being the supply of doctors and psychologists remains artificially constrained due to the still broken healthcare and academic industrial complex.

The Front Line

Front-line police are getting more specialized training in handling and deescalating situations and recognizing those in need of help and are working side by side with health care professional to create better outcomes instead of drawing on overloaded court and jail resources, that are counter-productive.

National 3-Digit Mental Health Crisis Line

Having someone to reach out to in a crisis is critical to saving lives.

No, don't call Empire Carpet.

Seriously though, the US has also adopted the mental health crisis line 9-8-8, allowing callers to instantly be connected to help when things are at their worst, deescalate problems and be redirected to in-person mental health resources or emergency care when needed.

Fighting Two Battles Simultaneously

There is also a realization that mental health issues and substance use issues share similar roots sometimes and that collocating treatment for both problems and adopting group counseling and treatment modalities can result in better outcomes. The expansion of community mental health centers is a major game changed.

These centers require fewer resources that psychiatric hospitals with partial-hospitalization programs (ie intensive outpatient program)s, and have quicker turn-around times, and can directing people to follow-on individual care through virtual means, like Zoom calls, after their intensive programs

Clinician marketplace platforms that provide a wide-swath of clinicians available from a large area, unencumbered by location due to the virtual nature of the treatment, that are qualified and work with the patient’s insurance.

These platforms offer integrated screening diagnostics and dashboards for the online treaters and the patients get the best information about their care and manage scheduling, along with insurance.

For the after the virtual care, the removal of the need to find transportation to care appointments and the ability to review a large marketplace of clinicians make mental health treatment possible on schedules that are more conducive to the goal of returning people to gainful employment, granted conditions varying on a spectrum of functionality depending on where the patient is in their care journey.

Digital Therapeutics

Phone apps are not just scroll addicting dopamine hits.

Healthcare scientists have been experimenting with means for people to log their mood and emotions, their symptoms, their behavior and medication adherence, along with sensor data from their smart watches.

Data on co-morbid health issues, like from sleep apnea machines as well as other sleep tracking tools, and mental health status can be charted and tracked and combined with provider health records. The information can summarized as a set of KPIs for the patient and can be shared with doctors for deep-dive analysis where they can learn more and bring more useful analysis to the exam room for shared problem solving.

Better Medications

Mental health medications have advanced considerably as have means to treat their side-effects which often can be severe (often sedation, substantial discomforts, and more serious concerns) and are one of the number one reasons adherence to medication is such a problem with patients. It can result in their difficulties in integrating into society in terms of safety, functionality, and productivity if they’re in the workplace.

Medications known as Long-Acting Injectables, delivered in a doctor’s office, typically once every three months, most particularly of anti-psychotics, make adherence much easier.

One visit, one shot and multiple months of stable levels in the system that bring better functionality into people’s lives.

In the past the monitoring of blood was critical as extreme dangers existed and required intensive management of levels of both the medication and other blood metrics, but the science and practice of that have evolved and the risk management has substantially improved.

Conclusion

While the social stigma, the skilled response gap, and clinician biases remain problems, progress is being made.

The artificial scarcity of specialized providers is being filled by social workers, mental health counselors, nurse practitioners, physician assistants, group treatment settings, and entire marketplaces with integrated remote care platforms.

Public views on mental health and the willingness to provide workable accommodations remain stumbling blocks.

Overall, change is being made and good things are on the horizon that we are expanding to.