By Susan Blumenthal, M.D., M.P.A. and Olivia Y. Lee
What if doctors could check a patient's brain vitals just as easily as taking their pulse or blood pressure? Recently, the Food and Drug Administration (FDA) approved several new technologies to help assess brain health and detect emotional and cognitive changes earlier when treatment can be most effective.
This year's Mental Health (May) and Brain Awareness (June) Months arrive at a time of intensified focus on mental illness and neuropsychiatric disorders at home and abroad, underscoring the need for new ways to quickly determine a person's mental and cognitive status in a variety of settings. These weeks of heightened awareness about brain health help promote the importance of early detection of illness and rapid intervention. And technology may be a part of the solution.
During routine medical checkups, physicians measure various physical vital signs such as blood pressure, temperature, pulse and respiratory rate. Any abnormalities in these screening tests would prompt the doctor to conduct or refer the patient for further testing. However, brain vitals -- a simple set of tests easily administered on a smartphone or tablet that measure mood, cognition, reaction time, spatial discrimination and memory -- have yet to be well integrated into routine medical check-ups. Such tests could augment health care professionals' diagnostic powers by allowing them to evaluate and track changes in standardized measurements over time.
Called a "brain thermometer" by the US Army's Combat Care Research Program, a new FDA-cleared app is proving helpful in military settings to help identify traumatic brain disorders (TBI), concussions, post-traumatic stress disorder (PTSD), and depression in members of the Armed Services. The tech expert, Dr. Corinna Lathan, behind this new software suggests that this tool could also be used in general health care settings as well. In the near future, it may be possible for doctors to take brain vitals on all of their patients, helping them catch worrying symptoms of emotional distress and neurocognitive changes that signal the presence of a TBI, concussion, or mental illness. Improving early detection of these conditions can help prevent needless suffering -- an important step in reducing the impact of mental illness and cognitive impairment in America and worldwide. The software might also be used during rehabilitation to evaluate progress or decline after a neurological event such as a concussion or stroke. This innovative app approach provides a portable, user-friendly method to evaluate multiple components of vital information related to brain health.
Globally, mental illness takes an enormous toll on individuals, families, and society as a whole,accounting for approximately 7.4 percent of the global burden of disease from all causes in 2010. In the span of two decades, from 1990 to 2010, the global burden of mental and substance abuse disorders increased by 37.6 percent, almost entirely attributable to population growth and aging. [1] Not only are these disorders increasingly prevalent -- they also do not discriminate, affecting people of all ages, races, socioeconomic groups and both sexes. In 2012, one in five American adults -- 43.7 million people -- experienced a mental disorder. [2] But only 41 percent received mental health services in that year. [3] Additionally, one in five children, ages 15 to 18, either currently or have at some point experienced a "seriously debilitating"mental disorder. [4] And as more members of the baby boom generation reach the age of retirement, mental illness is expected to take an increasing toll on the already-stressed U.S. health care system.
A glance at the numbers demonstrates the enormous human and economic costs of mental illness -- in dollars and in lives.
- The direct and indirect costs of mental illnesses to the U.S. economy is an estimated half a trillion dollars a year. [5] Medical expenditures for mental illnesses in the U.S. were $57.5 billion in 2006. [6]
Given the high prevalence of mental illnesses, their painful symptoms and costs to society, why don't more Americans seek mental health services? There are many reasons, but two explanations include the lack of health care coverage for mental illness and a lack of awareness of the symptoms and impact of these disorders. A new report released last month by the National Alliance on Mental Illness (NAMI) helps explain the health coverage factor. The report revealed that mental health parity (equal insurance coverage for mental illness as for physical health problems) was far from a reality despite passage of the Mental Health Parity and Addiction Equity Act in 2008 and the Patient Protection and Affordable Care Act of 2010. In other words, many people still cannot afford mental health services because their insurance does not provide comprehensive coverage for treatment of these disorders.
The second reason is that people often don't recognize symptoms of a mental disorder in its early stages. In fact, according to the National Institute of Mental Health (NIMH), the median delay between the appearance of first symptoms and seeking treatment for mental illness is nearly a decade. [12] Furthermore, stigma still surrounds these disorders so that many view them as personal weaknesses or character flaws, rather than as real, disabling illnesses just like heart disease or diabetes. This postponement of seeking treatment can result in more severe, more difficult to treat conditions as well as the development of co-occurring addictive disorders.
Mental illnesses are very widespread and can be health damaging, but they are also observable and treatable. A cornerstone to achieving better mental health outcomes lies in screening and early detection. A study revealed that when screening tests were administered during a primary care visit, doctors were over three times more likely to recognize the symptoms of mental illness and to follow up with their patients. [13] Treatment for mental illnesses detected through such screening tests has also been shown to effectively reduce patient's symptoms. Between 70 and 90 percent of individuals experience decreased symptoms and improved quality of life with a combination of pharmacological and psychosocial therapies. [14] These findings underscore how important it is to better integrate mental health into primary care.
Efforts to promote early detection of mental illness are not new. Various screening tests already exist for identifying signs of mood disorders and cognitive changes including memory impairment. However, these tests are not regularly administered at routine medical check-ups. If they are included, depending on the way the physician asks the questions, or due to any miscommunication between the doctor and patient, the results may vary. What technological tools offer is a standardized measurement system that may be less prone to subjectivity and bias. Some patients may answer questions more accurately if they are responding to an electronic test compared to answering questions by their primary care doctor. Additionally, patients may perform simple cognitive tasks more easily without the presence of a physician waiting for their response. Additionally, some health care providers and patients are not comfortable talking about mental health issues. Moreover, having an app collect data can save time for a primary care doctor and allow them to follow up with questions as well as map trends in their patients' mood and cognition over time. These types of technologies cannot and should not supplant the doctor-patient relationship; rather, these e-screening tests would add another useful tool to the physician's diagnostic toolbox. They can also collect information that is helpful in determining the need for referral to a mental health professional or neurologist. And in the future, these apps might be applied in settings beyond the doctor's office - on the battlefield, in schools and in athletic arenas -- to assess psychological and cognitive functioning after an injury or other traumatic event.
In 2009, a study found that the simple act of a surgical team asking a set of nineteen questions before and after an operation such as, "Do we have the right patient?" and "What operation are we performing?" reduced the rate of deaths and postoperative complications by about 30 percent. [15] Similarly, the simple act of measuring "brain vitals" during routine medical check-ups as part of a verbal mental status exam and with e-screening tools could increase the detection of mental illness, TBIs, PTSD, and cognitive impairment in clinical practice. New mobile technologies may also help reduce the high costs and needless suffering associated with these disorders by detecting these conditions earlier when treatment can be most effective. The observance of Mental Health and Brain Awareness Months provides opportune moments to highlight such innovations for improving mental health care in the 21 century.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is a Senior Fellow in Health Policy at the New America Foundation and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. She is also Senior Policy and Medical Adviser at amfAR, The American Foundation for AIDS Research. Dr. Blumenthal served for more than 20 years in senior health leadership positions as a leading expert in the federal government in the Administrations of four U.S. presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also was a White House Advisor on health. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch, Head of the Suicide Research Unit, and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. She has chaired numerous national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the 2009 Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation. She is the recipient of the Rosalind Franklin Centennial Life in Discovery Award.
Olivia Lee is a sophomore at Dartmouth College, pursuing a degree in History with a minor in International Studies. She is a Health Policy Intern at the New America Foundation in Washington, D.C.
[1] Whiteford, Harvey A. et al. "Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010." The Lancet, 382 (2013): 1575-1586, doi: 10.1016/S0140-6736(13)61611-6
[2] "Mental Health by the Numbers." National Alliance on Mental Illness. Jan 2015. https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers.
[3] Substance Abuse and Mental Health Services Administration. "Results from the 2012 National Survey on Drug Use and Health: Mental Health Findings." Substance Abuse and Mental Health Services Administration. 2013. http://www.samhsa.gov/data/sites/default/files/2k12MH_Findings/2k12MH_Findings/NSDUHmhfr2012.htm.
[4] "Mental Health by the Numbers." National Alliance on Mental Illness.
[5] Rampell, Catherine. "The Half-Trillion-Dollar Depression." The New York Times. 2 July 2013. http://www.nytimes.com/2013/07/02/magazine/the-half-trillion-dollar-depression.html?_r=0.
[6] Soni, Anita. "The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian Noninstitutionalized Population." Agency for Healthcare Research and Quality. July 2009. http://meps.ahrq.gov/mepsweb/data_files/publications/st248/stat248.pdf.
[7] Whiteman, Honor. "Mental illness linked to increased risk of heart disease, stroke." Medical News Today. 27 Oct 2014. http://www.medicalnewstoday.com/articles/284461.php.
[8] Bakalar, Nicholas. "Depression Tied to Increased Risk of Parkinson's Disease." The New York Times. 20 May 2015. http://well.blogs.nytimes.com/2015/05/20/depression-tied-to-increased-risk-of-parkinsons-disease/.
[9] "Mental Health by the Numbers." National Alliance on Mental Illness.
[10] "Suicide: Facts at a Glance." Centers for Disease Control and Prevention. 2012. http://www.cdc.gov/ViolencePrevention/pdf/Suicide_DataSheet-a.pdf.
[11] "Mental Health by the Numbers." National Alliance on Mental Illness.
[12] "Mental Illness Exacts Heavy Toll, Beginning in Youth." National Institute of Mental Health. 6 Jun 2015. http://www.nimh.nih.gov/news/science-news/2005/mental-illness-exacts-heavy-toll-beginning-in-youth.shtml
[13] "B4Stage4: Get Screened." Mental Health America. http://www.mentalhealthamerica.net/b4stage4-get-screened.
[14] National Alliance on Mental Illness. "Mental Illness Facts." Grading the States: A Report on America's Health Care System for Serious Mental Illness. 2009. http://www2.nami.org/gtsTemplate09.cfm?Section=Overview1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=75341.
[15] Haynes, Alex B. et al., "A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population." New England Journal of Medicine, 360 (2009): 491-499, doi: 10.1056/NEJMsa0810119
___________________
If you -- or someone you know -- need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.