A panel with Doctor On Demand, NeuroFlow, Hims & Hers and Amwell discussed at Invent Health
One of the most notable changes in mental health treatment since the 1980s has been a surge in the use of psychotropic drugs; In fact, a 2011 report by the National Center for Health Statistics (NCHS) found that the rate of antidepressant use in this country among adolescents and adults, that is, those aged 12 and over, rose about 400 between 1988 and 1994 % has increased. as well as between 2005 and 2008.
Now, thanks largely to the pandemic, the number of people is increasing Prescription mental health drugs are on the rise, and over 65 million Americans are now taking these drugs. Overall, 18 states saw the number of people taking prescription mental health drugs increase between 10% and 20% over the past year, with Colorado, West Virginia, and Montana seeing the largest increases.
All of this is happening at the same time as a major shift in health care that would potentially signal a decline in drug use as it becomes more value-based and holistic, and becomes a system where a person’s entire life is viewed as part of their health.
During Vator’s The Future of Mental and Behavioral Health and the UCSF Health Hub, the idea of breaking away from a drug-reliant mental health system came up at a panel led by Bambi Francisco Roizen, Founder and CEO of Vator, and Dr Archana Dubey, Global Medical Director at HP.
“Archana and I have been talking from the beginning of this program about how we are moving from health care to self-care and moving away from all of this pharmaceutical science. That kind of input, or reductionist approach, just a psychrotrophic for a mental illness towards behavioral research, “Francisco said.
“Do you agree that we are moving from this old pharmaceutical science to a new behavioral science? And if you agree, has it been difficult for you to articulate this to your customers?”
The first to answer was Dr. Peter Antall, chief medical officer at Amwell, who said it was “oversimplification to say that we are moving from one model to a new model,“even if there was” an acceleration in the use of digital technologies and tools “.
“We’re seeing more self-help, more mindfulness, and mindfulness is trending for all the right reasons, because it can be a very effective tool. So we’re seeing a acceleration of many tools that are not pharmacological, but I don’t. Don’t you see, that this is being done in lieu of the proper use of pharmacological agents when appropriate, “he said, noting Cases where major depression debilitates, or illnesses such as bipolar disorder or schizophrenia, and medication are often useful and necessary.
While we are better In terms of the non-pharmacological tools, as well as providing new and different ways for the patient to access care, that doesn’t mean sacrificing the other types of care, he said.
“We also help overcome stigma. I keep hearing from different patients or different populations, usually anecdotal, that: ‘I would never have gone to a practice called psychiatry and treated there, but I can be comfortable there . ” from home and I don’t have to worry about seeing my neighbor in the waiting room, I’m ready to get involved. ‘ There are many good developments out there, but they do not have to come at the expense of proper drug use when necessary or appropriate. “
Dr. Ian Tong, Chief Medical Officer at Doctor on Demand, agreed, noting that “we have all just had the toughest year we have ever been through in our lives. “
“Because so many people had such a tough year, it actually removed a tremendous amount of stigma down the line so we can all feel the greatest excuse to acknowledge all of our behavioral or mental health concerns and issues.” , he said
Nevertheless, according to Tong, the various forms of treatment are not in competition with one another and “We need the full spectrum or the full range of an arsenal.”
“When you ask a doctor this question, it’s natural for us to go, ‘Look, we know for the severely ill and the ICD-10 diagnostic clinical elevations, we can do some things with them and the drugs work very.” Well.’ But I know that there are also concerns on the part of the payers: ‘But aren’t we overmediating people because everyone is now into something and we reach for it too easily?’ And that’s why I think it’s good that we’re having this debate, but it’s neither one nor the other, “he said.
Ultimately, it’s all about Get smarter and learn as much as you can about all tools, including coaching and social determinants of health, which can also have a major impact on mental and physical health.
“There are larger things that are not necessarily clinically relevant but may be defined by your zip code that have a huge impact on your mental health and wellbeing and your ability to find physical opportunities. We talked about going for a run: there are some places where people don’t go running because it’s not safe in their neighborhood. We need to figure out the tools these people need and sometimes those aren’t clinical, “Tong said.
Chris Molaro, CEO of NeuroFlow, also agreed: “It’s not a zero-sum game, it’s about the right care at the right time and measurement-based care.”
“This is where technology can help help the care organizations figure out who is actually taking those therapeutics and drugs, and then therapeutics plus coaching could make a huge difference as opposed to a pill that won’t be the silver bullet. If you can improve this and measure the results and say, “Wait a minute, this is going the wrong way, maybe we should think about stopping them or changing their medication, changing their dosage,” then data can help clarify this care delivery. “
Dubey asked Dr. Patrick Carroll, Chief Medical Officer at Hims & Hers, how his company helps its customers, who are mostly millennials and therefore often on the younger side.
“As a practicing clinician, I see that it is easier for my younger population to introduce drugs to treat mental illness than older people, as mental illness is naturally stigmatized, but so are medications for mental illness,” Dubeyy said.
“There’s a lot more acceptance among the younger population: ‘Yes, I needed help. I also needed medication.’ And how do you develop clinical protocols for this? “
Carroll replied that in the 30 years he spent as a family doctor, saw very few millennials and noticed that they are uncomfortable talking about the issues that Hims & Hers brings up, including hair loss and sexual health, which is why it made sense to add behavioral health.
“As a family doctor, I know that talk therapy would only go so far for some patients and that medication plays a very valuable role. So we decided to offer a holistic approach to behavioral health, “take care,” he said.
That is why the company offers Free group sessions on topics that include dealing with stress during the pandemic, as well as individual psychotherapy that Hims & Hers is building for each state.
“You have to take a holistic approach because behavior-related health problems, even if you focus only on anxiety and depression, can be very complex and one size doesn’t fit everyone. For most patients it is a combination of psychotherapy ”and medication. This seems to be most effective especially for our population, although not every patient is on medication, which is great, but many need it, along with psychotherapy. “
Antall closed the discussion by dampening some of the excitement for the new tools and new ways of thinking about mental health treatment, and acknowledging that “Trends come and go. “
“There was certainly a time when SSRIs were the big thing and everyone went on Prozac for minor outliers in their lives. I’m obviously exaggerating, but it’s important to realize that there may be some when something is trending. “Worth there, but sometimes the pendulum swings a little far during these stages,” he said.
“One reason I mention this is that the tried and tested methods of CBT and other forms of talk therapy are still very valuable, and are often the treatment most associated with long-term remission or resolution of the disease. We have a lot of shiny new toys in healthcare IT these days, and a lot of them are wonderful and play a role, but we also try to remember what is evidence-based and well-established and often very effective. “
(Image source: aarp.net)