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How We’re Building Better Mental Healthcare

Recovering from depression or anxiety is difficult. Unlike other illnesses, patients cannot be prescribed a miracle medication that immediately makes them feel better. To make matters worse, a majority of patients barely see their providers, making recovery unlikely.

Recovering from depression or anxiety is difficult. Unlike other illnesses, patients cannot be prescribed a miracle medication that immediately makes them feel better. To make matters worse, a majority of patients barely see their providers, making recovery unlikely.

The fact of the matter is that many traditional hospital systems do not adequately address the challenges posed by mental health conditions. Today, patients struggle to see their providers. When they do, treatments — developed under the assumption that “one-size-fits-all” — aren’t always effective. And even if their initial treatment works, patients don’t get the support they need to make a full recovery.

Each step of mental healthcare is taxing. At Prairie Health, we understand this. That’s why we help people throughout their care journey. Here, we share how we do so and the clinical evidence that supports our efforts.

Step 1: Connecting people to providers

One major issue in mental healthcare is that it’s difficult to even see a psychiatrist. After patients make an appointment, they wait a minimum of 25 days on average before they can see a psychiatrist. Within that time, 25% of patients stop seeking care — approximately 1% of all patients each day.

Making an appointment is only half the battle. There are many barriers that prevent people from seeing a provider. For example, patients often worry about being judged by their friends, family, and co-workers for seeking treatment. Others simply cannot fit treatment into their daily routines.

67% of depressed patient expect consequences at work if they disclose their condition, more than double the percentage (29%) for patients with diabetes, another chronic condition. Stigma is just one of the barriers that prevents patients with depression and anxiety from seeking care.

Given the barriers that prevent people from receiving care, it’s no surprise that over half of people with depression or anxiety do not seek mental healthcare. As a result, making it easy to see a provider is a key priority for Prairie. We connect our clients with a mental health professional right away. Clients are then able to see a Prairie psychiatrist as soon as a week after signing up for services, or within 3 weeks if they decide to do pharmacogenomic testing.  (We use pharmacogenomic testing to improve treatment — more on this later.)

Our clients can also fit mental healthcare into their lives where and when it works best for them because we offer care over video and text. Known as telepsychiatry, this improves access in various ways. First, it’s convenient, giving patients the necessary flexibility to make their appointments. It also makes it easier for patients to avoid stigma. And perhaps most importantly, telepsychiatry is effective. Clinical evidence has also proven that it is at least as effective as in-person care. With all these benefits, it’s no wonder that patients report high levels of satisfaction with telepsychiatry.

Step 2: Personalizing treatment to each individual

Unlike other medical specialties, psychiatry has historically taken a trial-and-error approach to medication. Many patients have to try multiple medications to find one that works. This presents a major problem for patients, as they must wait weeks for their antidepressantsto take effect. Between waiting for a medication to work and switching to a new one, treatment can take months or longer.

Part of the problem is that antidepressants were developed under the assumption that “one size fits all”. However, we now know that isn’t the case. For example, many psychiatric medications were developed before diversity was a requirement for clinical trials. As a result, corresponding dosing guidelines may not be appropriate for women and people who are nonwhite.

Even if a psychiatrist prescribes the right medication for a patient on the first try, it still takes most patients 2 months or greater to recover from depression.

That’s why we offer clients the option of pharmacogenomic testing (also called pharmacogenetic testing, or simply genetic testing) to help our psychiatrists tailor treatment for individual patients. Pharmacogenomic testing allows our psychiatrists to make more informed treatment decisions based on a patient’s unique biology, using guidelines endorsed by professional societies such as the Association for Molecular Pathology. Some patients require lower doses of antidepressants, while some patients simply cannot process certain medications. Pharmacogenomic testing allows psychiatrists to take these factors into account and find the right medication faster. Several clinical trials have validated this approach, particularly for patients with treatment-resistant depression. While pharmacogenomic testing isn’t the end-all be-all, it certainly helps patients find a medication that works for them.

At Prairie, we’re moving psychiatry forward by giving psychiatrists the information they need to make better treatment decisions. We’re starting with pharmacogenomic testing, and are working towards incorporating machine learning techniques, given their potential to further personalize care.

Step 3: Supporting people throughout their care journey

It takes months to fully recover from depression and anxiety using antidepressants. During these months, many patients suffer from side effects. Others simply do not benefit from their current medication. As a result, one in five patients stop taking their medication within the first few months of starting, and a majority do not take their medications as prescribed. Unsurprisingly, this results in worse outcomes, such as a higher likelihood of relapse.

Even if a patient does feel much better right away, ending treatment early can also result in relapse. While the Food and Drug Administration (FDA) recommends weekly visits after starting an antidepressant, a majority of patients wait over a month to see their providers.

Care management can address these issues. At Prairie, clients are paired with a Care Coordinator who supports them at every step of their mental health journey. This includes, but is not limited to:

  • Providing psychoeducation around medication and treatment expectations
  • Answering questions about care
  • Sharing mental health resources
  • Coordinating care with other healthcare professionals
  • Providing administrative support as needed

This support results in better outcomes. Patients see more substantial improvements in their mental health, are more satisfied with their care, and experience a higher quality of life overall.

It’s an arduous journey to get mental healthcare. Unlike other specialties, no short trip to the hospital can truly make a difference for patients. And every step, from connecting to a psychiatrist to finding a treatment plan that works for them, presents unique barriers that ultimately prevent patients from recovering.

This simple fact guides the type of care we provide at Prairie. People shouldn’t have to wait a month to see a psychiatrist. They shouldn’t have to suffer from a trial-and-error treatment process. They shouldn’t have to spend months recovering without the help of a professional.

With these issues in mind, we’ve built a care model that offers a variety of clinically validated services to our clients. As a result, our clients have a higher chance of making a recovery faster compared to the current standard of care.

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Fri Sep 11 2020

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