Panel, Conference Presentation
Building the Mental Health System We Need
Milken InstituteRobert Wilkie, Freda Lewis-Hall, Kay Jamison, Ronald Kessler, Robert Nelsen, Richard Pops, Brandon Staglin, Ron Kessler, Bob Nelson, Shawmi Finless
- Panelists anticipate that precision medicine, longitudinal quantitative phenotyping, and genotyping will redefine diagnosis and therapeutic development, with a revolution in data and passive monitoring via wearables, voice, and machine learning expected within the next one to two years.
- Specific solutions under development include next-generation neurosteroids shifting the paradigm to treat depression as an acute condition, One Mind's expansion of coordinated specialty care into a learning healthcare network in California, and early screening tools for psychosis risk in schools.
- Quantification of mental health issues is projected to enable stigma-free interventions based on numerical goals and improve outcomes, with one clinical trial citing a 40% to 50% cost reduction through a single app.
- Future expectations include the use of biomarkers to test innovative psychosocial treatments through the Accelerating Medicines Partnership for Schizophrenia and a regulatory shift driven by patient and legislative pressure to accelerate approval processes for new medicines similar to changes seen in cancer and HIV.
- A major shift in treatment practices is predicted where measurement-based care and big data will identify effective interventions, leading to the expansion of high-performing programs and the cessation of those with poor outcomes, potentially rendering current depression diagnoses obsolete in favor of data-based taxonomies within 20 years.
- Significant risks include low treatment adherence due to emotional barriers and poor tolerability of current drugs, a healthcare system lacking awareness compared to other medical fields, and the lack of integrated care causing depression to be overlooked in favor of physical complaints.
- Operational challenges involve under-resourced and overwhelmed schools that cannot effectively implement early interventions, as well as current FDA requirements for the Montgomery-Asberg Depression Rating Scale that may not align with actual pharmacology or neurocircuitry.