Mental illness might be smarter than us. It seems to have figured out how to get around asking for our permission and instead to beg for forgiveness once damage to function and health already has been done.
That’s the only way to explain the following: it takes not five weeks or three months but 11 years for someone who exhibits signs of mental illness to first seek help for that disorder. That is, if they even seek help, as many never do. Imagine watching your daughter fall and break her arm, and then waiting 11 years to take her to the emergency room. Or, imagine your son having seizures, and no one noticing or suggesting that he see a doctor for over a decade. Sound absurd? As a child psychiatrist, I think so too.
As physicians, we see the result of this delay in care every day in the emergency room, hospital, and clinic. We bring the 56-year-old prescription painkiller user back to life with an injection and know that her next overdose might kill her. We hear sirens as they wheel in the depressed 32-year-old who tried to shoot himself in the head. We see the homeless man with schizophrenia who was just in jail for trespassing. What do all of these people have in common? They were all kids once. And their mental illness had to start somewhere. It’s time that we start there too — and allow innovative, technology-based solutions to help.
According to the NIMH, half of all mental illness begins by age 14. This means that half of all mental illness could hypothetically be caught and treated before kids leave school and, usually, their parents’ homes. This idea of early detection and intervention is not a new one. At birth, babies are required to get specific tests to look for certain disabling disorders that could have a better prognosis if caught early. Additionally, when kids are school-aged, they have their hearing and vision tested, and are required to have well-child checks by their pediatricians. Yet, aside from a quick question about depression and suicidality by a particularly good pediatrician, a formal assessment or screening for mental illness is likely never conducted.
Every year, we pay for not intervening earlier. According to SAMHSA, the projected 2020 spending on mental health and substance use disorders is $280.5 billion, which is more than the projected total of the next three costliest disorders combined, including diabetes, heart disease, and neck and back pain. What’s less obvious is that this number represents direct costs alone. It would likely be doubled if it were to include the indirect cost of potential earnings per year lost due to mental health-related disability, the cost of public disability insurance payments, and the costs related to incarceration and/or homelessness in people with mental illness. What’s more is that people with mental illness are more likely to have and require treatment for other illnesses such as diabetes, heart disease, and cancer.
Tackling these mental health challenges through early intervention seems like low hanging fruit when it comes to ways in which to improve quality of life, decrease disability, and decrease unnecessary expenditures. Yet stigma related to seeking help, lack of adequate access to care by those who need it, and a shortage of mental health providers historically have been big obstacles to action. If, in this new age, technology could place that fruit in our hands and tell us what to do with it, would we still wait another 11 years to act? With new technological innovations entering the market each month, our repertoire of resources is starting to change. Now our actions and initiatives must change with it.
The advantages of using technology in mental health are clear. It offers novel ways in which to extend the reach of what is currently available in diagnostics, treatment, and care coordination. In addition, technology-based tools are easy to scale, standardize, and interpret. They would allow for easier measurement of outcomes and the information could be aggregated on a wide-scale in order to guide population-based interpretations and interventions. With active and passive data monitoring tools, chatbots, text therapy, talk therapy, virtual reality, telepsychiatry, and more — there is new potential not only to detect illness but to meet unmet treatment needs.
The ideal place to focus these new efforts and innovative solutions is on kids — before they grow up to become some of America’s costliest and most disabled adults. Using these new tools with children and adolescents offers a unique opportunity as compared to adults for two reasons: 1) kids generally are more open to the use of technology to begin with, and 2) there are certain places that all kids are required to be, either by law or by their parents, and the new tools could be used in those places. Schools are a great example. The average child in the U.S. spends upwards of 12,000 hours of his or her life in grade school. In theory, we should be able to borrow one or two of those hours.
Criticisms of school-based screenings include concern over the lack of available resources in schools, potential for over-diagnosis, and biases toward students labeled as having a mental illness. In light of these concerns, the use of technology-based screening tools in the pediatrician’s office may be a more feasible starting point. For those with identified disorders, early referrals could be made by pediatricians to psychiatric providers, or any of the number of new technology-based modalities could be used for fast and widespread treatment.
The problem that undiagnosed and untreated mental health poses is clear, and the time to intervene was yesterday. A new way to do so is at our fingertips, if we use the help of technology. It is the creative development of concrete, scalable solutions that is left. If the same dedication put forth by data scientists, engineers, and the brightest minds working to cure cancer or AIDS were put toward developing new solutions for mental health, the field finally would see the transformation it has needed to for decades.
Neha Chaudhary is a child and adolescent psychiatrist and can be reached on Twitter @nehachaudharymd.
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