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1、Embracing innovation in mental healthSUPPORTED BY仅供“全球精神健康”在线课程学生参考使用 The Economist Group 2022Embracing innovation in mental health2Contents3 Introduction 4 The mental health innovation landscape:where are we now?5 Increasing access:overcoming barriers to care5 Funding challenges 5 Detection and dia
2、gnosis5 Stigma and outreach8 Beyond stigma10 Understanding mental illness:innovations and opportunities in research10 Trial recruitment and design11 The slow progress of innovation in medication11 Telehealths time has come13 Delivering care:solving the provider shortage14 Burnout among providers14 B
3、uilding a more resilient workforce15 Deepening knowledge:data,reporting and infrastructure15 Innovative data solutions17 The way forward19 Appendix:About this report21 References仅供“全球精神健康”在线课程学生参考使用 The Economist Group 2022Embracing innovation in mental health3IntroductionThe covid-19 pandemic has s
4、hifted the healthcare landscape worldwide and,in doing so,has revealed opportunities to meet challenges that far predate it.Reinvention,however,presents its own challenges.With much change underway,it is essential that all stakeholders think creatively about how to ensure that new tools and approach
5、es improve services available to patients.One area in need of change is mental healthcare.The pandemic has placed exceptional strain on the mental health of many people,increasing an already substantial burden.Depression is currently among the leading causes of disability in the US.1 To address ment
6、al health issues at the required scale,innovation is key.The World Health Organization(WHO)combines social,science and business aspects in defining innovation in healthcare as the development of“new or improved health policies,systems,products and technologies,and services and delivery methods that
7、improve peoples health,with a special focus on the needs of vulnerable populations.”2This report examines the current landscape of innovation in mental healthcare,including challenges such as implementation and achieving scale and sustainability.There are many areas for growth,including overcoming t
8、he obstaclessuch as stigmatizationthat hinder patients from seeking care.For those who do seek help,further challenges arise,including provider shortages and the correlated high cost of care.Another key areaand one that offers fertile ground for innovationis data use.Accurate,interactive tools are n
9、eeded to track both the prevalence of mental illness and patient outcomes.By examining the role of innovation in mental healthcare,we can leverage the momentum Figure 1.Defining innovation in healthSource:WHOScientific innovation(R&D)Business innovationSocial innovation仅供“全球精神健康”在线课程学生参考使用 The Econo
10、mist Group 2022Embracing innovation in mental health4generated by the pandemic.Despite widespread recognition of the need to improve mental healthcare in the US,there is much to be done.The mental health innovation landscape:where are we now?Efforts to improve mental health treatment in the US requi
11、re innovative thinking to address a multitude of challenges.Funding for mental healthcareand thus the ability of services to meet needsremains insufficient,and parity of care with physical health services is still a target rather than reality.“The way our system is working at this point is similar t
12、o a sink overflowing with water,”says Maggie Merritt,executive director of the Steinberg Institute,a California-based advocacy group dedicated to mental health policymaking.“And were spending the majority of our time trying to mop up that water versus just turning off the spigot.”Challenges spanning
13、 access and outreach,diagnosis and treatment all require an innovative push to bring services to a consistently effective level.仅供“全球精神健康”在线课程学生参考使用 The Economist Group 2022Embracing innovation in mental health5Increasing access:overcoming barriers to careSome of the biggest challenges to providing
14、effective,equitable mental health services arise before people opt to seek help.Difficulties in affording or even finding suitable services are a key challenge to many people in the US.Mental health is also especially subject to stigmatization,which often prevents people from acknowledging(at least
15、openly)that they may require assistance.Significant challenges also exist in relation to funding services and research,while issues linked to stigmatization go hand in hand with difficulties in outreach,and in detection and diagnosis of problems.Funding challengesIncreased funding for mental health
16、treatment is necessary.In 2015,mental,neurological and substance abuse disorders made up 22%of total disability-adjusted life years in the US,yet only 8.2%of government health funding addressed mental health.3While the expansion of insurance coverage through the Affordable Care Act has increased cov
17、erage for many individuals,there has not been a parallel increase in people receiving treatment for their mental health.4 Further creative outreach efforts are clearly needed.Detection and diagnosisEarly detection is essential to effective mental health treatment.Yet,for many reasons,including the e
18、nduring stigmatization of mental health issues and barriers to access driven by poorly resourced services,health services fail to engage potential patients.In addition,diagnosis of mental illness relies primarily on patients self-reporting their symptoms.Examples of innovation to improve detection a
19、nd diagnosis include practical initiatives such as integrating mental health awareness into formal education curricula for medical students in order to improve outreach to potentially vulnerable individuals.Such innovation includes technological solutions such as smartphone-based“digital phenotyping
20、”tracking patient activity and location,voice-and speech-related indicators,and humancomputer interactionsto assist in diagnosis and monitoring.5,6Stigma and outreachSocial stigma has long been associated with mental health conditions.It is often still considered taboo for people to admitto clinicia
21、ns,but also to family and friendsthat they may need help.Individuals diagnosed with mental illness still experience discrimination,which not only makes 仅供“全球精神健康”在线课程学生参考使用 The Economist Group 2022Embracing innovation in mental health6people less likely to come forward but also creates challenges an
22、d limitations in researching potential treatments.7While it is essential to improve the care offered to current patients,it is also critical to expand access to services by eliminating cultural barriers that prevent people from coming forward.For example,people of color are both more likely to exper
23、ience cultural stigma around mental illness,disincentivizing them from seeking care,and less likely to find a provider who can offer care that is sensitive to the unique issues facing minority communities in the US.8Barriers to help-seeking can be especially pronounced among racial and ethnic minori
24、ty groups,making it less likely that individuals from these communities will seek help.9 These culturally specific barriers have been conceptualized as fitting into three categories:affective barriers,which include stigma and reluctance to seek care because mental health treatment has primarily been
25、 tailored to White Americans or,in some cases,has treated people from minority ethnic backgrounds as being mentally inferior;value orientation barriers,including difficulties in squaring individualistic treatments such as psychotherapy with more collectivist cultural beliefs(as can be the case with
26、people of Latin American or Asian backgrounds,for example);and physical and structural barriers linked to socioeconomic status,language and bias or prejudice on the part of healthcare providers.10Figure 2.Instance of mental illness compared to the proportion of people receiving treatment,by race/eth
27、nicity,United States.WhiteBlack or African AmericanAmerican Indian orAlaska NativeAsianTwo or more racesHispanicAsianTwo or more racesBlackWhiteHispanicSource:American Psychological Association(data originates from the Substance Abuse andMental Health Services Administration)9Any mental illness in t
28、he past year among adults,by race/ethnicity,2008-12(annual average percentage)Among people with any mental illness,percent receiving services,201595%confidence intervals%19.0%16.8%22.7%13.4%24.9%15.3%48%31%31%22%46仅供“全球精神健康”在线课程学生参考使用 The Economist Group 2022Embracing innovation in mental health7Hea
29、lth provider bias is not necessarily active(or even subconscious)prejudice;it can also simply reflect a lack of awareness of culture-specific issues,including the unique stressors of living in a country with deep racial disparities.Nathaniel Counts,senior vice president of behavioral health innovati
30、on for Mental Health America,identifies this challenge as“a systemic issue about the way we measure mental health that undercounts psychological distress among people who experience consistent adversity.”“If youve seriously experienced a lifelong series of adversity and disinvestment,it might not sh
31、ow up as a relative change that a clinician can recognize as depression,”he says.“And so theres this phenomenon where White people get diagnosed with depression and Black people get diagnosed with diabetes;where for people of color mental health is more picked up in cardio-metabolic impacts than men
32、tal health impacts.”People with mental illness,especially individuals of color,often do not receive a mental health response to a mental health crisis,instead receiving help through underresourced(especially in mental health terms)emergency departments(EDs)or even through law enforcement.One in four
33、 fatal police shootings in the US between 2015 and 2020 involved a person with a mental illness,and an estimated 44%of people in jail and 37%of people in prison have a mental health condition;2m people with mental illness are booked into US jails every year.11Although these data demonstrate that the
34、re is a long way to go,there have been examples of innovation in this area.For example,24/7 call centers have been established to answer 988(suicide-prevention line)calls locally,responding with mobile crisis teams and crisis-stabilization programs,seeking to close the revolving door of ED visits,ar
35、rests,incarceration and homelessness.11Patients who do seek mental health assistance also face challenges.Such patients typically approach their primary care physician for help,but when referred to a mental health professional,they often decide against pursuing treatment because of perceived stigma
36、or feeling uncomfortable about working with a new organization and provider.“If a medical professional refers a patient to a mental health facility,in about 6070%of cases,the patient wont accept the referral,”says Alexander Blount,professor emeritus of family medicine at UMass Chan School of Medicin
37、e and president of Integrated Primary Care.An initiative to combat patients reluctance is one insurance companys Depression in Primary Care Program,which supports primary care physicians by assisting with diagnosis and treatment of depression.Support includes a screening tool and reimbursement for d
38、epression screening and follow-up monitoring.Case managers become directly involved by following up with the patient and then updating the primary care doctor on their condition.12 This sort of innovation helps to circumnavigate the issue of stigma by empowering primary care physicians to better ass
39、ist patients.Recruiting and training individuals from local communities can also help increase understanding and reduce stigma while addressing workforce shortages.“If you want to grow your own workforce“If you want to grow your own workforce members to augment the current primary care behavioral he
40、alth workforce.get workforce members who already know the patients,people who are very likely to be of the culture of your underserved patients.”Alexander Blount,professor emeritus of family medicine at UMass Chan School of Medicine and president of Integrated Primary Care仅供“全球精神健康”在线课程学生参考使用 The Ec
41、onomist Group 2022Embracing innovation in mental health8members to augment the current primary care behavioral health workforceor if youre going to start with enhancing the behavioral health skills of medical assistants,medical interpreters,or community health workersyou get workforce members who al
42、ready know the patients,people who are very likely to be of the culture of your underserved patients,”says Mr Blount.Beyond stigmaStigmatization of mental health problems is a clear,longstanding issue.Yet the reasons that people do not pursue care are vast,spanning a lack of faith in the treatment a
43、vailable to them,a lack of knowledge about how or where to seek treatment and not feeling that they require treatment(which suggests space for innovative thinking on how to educate people about recognizing symptoms).The largest barrier is cost(cited by 38%of people in a 2016 survey),and significant
44、numbers of people say that insurance coverage is either insufficient or nonexistent for mental health services.13仅供“全球精神健康”在线课程学生参考使用 The Economist Group 2022Embracing innovation in mental health9Figure 3.Why people in the US do not receive mental healthcare despite needing itNote:response categorie
45、s are not mutually exclusive;respondents could indicate multiple reasons for not receiving mental health services.Source:American Psychological Association(data originates from the 2016 National Survey on Drug Use and Health)13Could not afford cost 38%Thought could handle the problem without treatme
46、nt 28%Did not know where to go for services 21%Did not have time 20%Health insurance does not pay enough for mental health services 13%Concerned about being committed or having to take medicine 12%Might cause neighbors or community to have negative opinion 11%Treatment would not help 10%Did not feel
47、 need for treatment at the time 10%Some other reason 9%Concerned about confidentiality 9%Might have negative effect on job 9%Did not want others to find out 8%Health insurance does not cover any mental health services 7%No transportation or inconvenient 6%仅供“全球精神健康”在线课程学生参考使用 The Economist Group 202
48、2Embracing innovation in mental health10The start-up sector has begun to make a foray into the world of mental health treatment,albeit focusing primarily on mindfulness and talk-therapy apps.While these are a useful first step,newer technological approaches may reveal more advanced ways for the indu
49、stry to become involved in care delivery.14 But while so-called disruptive approaches and a focus on new technologies will improve therapeutic offerings,there is also a need to innovate in less attention-grabbing ways,particularly in terms of conducting research and better understanding mental illne
50、ss and what constitutes effective treatment.Trial recruitment and designIssues with trial recruitment and design can impact the ability of researchers to gather an accurate,representative assessment of(for example)a treatments impact.Often,for instance,the sickest patients are excluded from trials,m