While well-intentioned, these broader screening measures have inadvertently exacerbated access issues. Primary care, oncology, and maternity clinics now face a growing administrative burden and, more concerningly, find themselves managing complex mental health cases beyond their scope. Virtual care partnerships offer a solution to this growing gap in care. 

The time is now

The increase in demand for mental health services, coupled with higher rates of severity and a limited number of psychiatric providers, has created a bottleneck in the healthcare system. For ambulatory clinics, the influx of patients with behavioral health needs, paired with limited referral options, is contributing to clinician burnout.

This widespread challenge is especially acute in states like Massachusetts, where primary care providers are mandated to screen children with MassHealth insurance for behavioral health conditions. Despite their best efforts, teens are often waiting six months or more to access care. Elsewhere around the country, clinics hesitate to screen patients at all, delaying treatment and risking preventable crises.

It doesn’t have to remain this way. Empowering ambulatory settings with direct referral pathways to trusted virtual providers can relieve this pressure and ensure timely, effective care for all.

How a comprehensive virtual partner can help

If your clinic is struggling with access challenges, new screening protocols, or a rise in behavioral health needs, a comprehensive virtual partner can help. By partnering with Brightside Health for referrals, you can unblock effective mental health screening and address the needs of your patients sooner.

Benefits include:

• Seamless referral pathways

Our simple workflow integration reduces the administrative burden and lets your clinicians focus on patient care. With insurance coverage for over 130 million people and appointments available in as little as 2 days, patients can quickly and easily access affordable care.

• Comprehensive care

Brightside Health provides care for teens, adults, and seniors. We treat mild to severe conditions, including suicide risk and substance use, ensuring all of your patients receive the appropriate treatment for their needs.

• Improved outcomes

By addressing mental health needs early in ambulatory settings, we can achieve better, lasting outcomes for all patients. Our high-quality care delivers proven results: 75% of patients achieve remission and 77% no longer experience suicidal thoughts after just 12 weeks.

Stronger together

At Brightside Health, we partner with organizations like yours to provide timely virtual mental health services for patients ages 13 and up. Get in touch today to learn more about our comprehensive mental health care solution. Together, we can ensure your patients receive the mental health care they need to thrive.

The post Mental Health & Ambulatory Clinics: Virtual Partnerships Fill a Critical Gap appeared first on Brightside.

A closer look at the problem
As the mental health crisis grows, hospitals and health systems are increasingly feeling the burden in the emergency department. Too often, staggering provider shortages leave patients in need of mental health care with nowhere else to turn. Based on a study from the Western Journal of Emergency Medication, ED visits for MHSA conditions are rising and 14.2% of patients return within 30 days. Difficulties implementing screening programs and managing comorbid mental health issues in specialty clinics only exacerbate the problem.

The keys to a successful care strategy
Virtual care can be a powerful solution to many of the issues facing high-severity mental health cases today, and should be applied as part of the greater strategy for traditional health systems. Not only does virtual care offer clinical-grade behavioral treatment to a broader set of people with complex conditions, it also helps solve multiple challenges.

1. Timely access & intervention
Scaled virtual mental health care platforms enable timely access and availability to care—both during critical periods and follow-ups. With tools to support a national network of vetted clinicians, 92% of our patients get seen within five days.

2. The right treatment pathways
A comprehensive offering of psychiatry, therapy, crisis services, and care coordination ensure that patients get the right levels of care for their unique needs. Further innovations in AI, machine learning, and data analytics enhances providers’ ability to personalize and optimize care.

3. Continued engagement
Engagement has always required additional resources and extra effort from staff who may already be stretched thin. Science-backed virtual tools create more options and pave a way for patients with complex needs to stay engaged between sessions. Our data shows that with continued engagement, high-severity populations attain better outcomes.

The proof is in the numbers
Several of our peer-reviewed studies have demonstrated the efficacy of our virtual care model in treating high-severity mental health conditions. Here are some highlights:

• 75% of patients achieved remission after 12 weeks of treatment
• 50% graduated our Crisis Care program in four sessions, with 90% continuing care online
• 77% of members with suicidal ideation had remission after 12 weeks of treatment
• 50% higher response and remission rates than a leading U.S. health system

Driving better outcomes together
Brightside Health offers the most comprehensive mental health care available, treating mild to severe needs. From therapy and medication management to programs for suicide risk and substance use—all individuals are able to receive treatment that includes innovative methods for maintaining engagement with an average of seven sessions per patient. These resources support health systems through a business model that aligns with better clinical outcomes and cost reduction initiatives across the behavioral health population. As health systems rethink their strategy to meet rising demand, collaborating with our proven virtual care model will yield meaningful outcomes for patients with mild to severe mental health conditions, including those with elevated suicide risk.

Ready to take the next step?
Reach out today and explore how Brightside can support your organizational strategy through simple integrations that address your service line needs.

The post Enabling Meaningful Outcomes for High-Severity Mental Health Management appeared first on Brightside.

An upstream problem  

There’s a growing prevalence of mental health issues in the U.S. One in five adults lives with a mental illness, 17% have a substance use disorder, and 12 million consider suicide each year. These rates are unfortunately rising steadily among both adults and teens. 

To meet this demand, health systems are looking to enhance their services and overcome provider shortages and financial constraints. The current national provider shortage makes it challenging to hire additional providers and, while health systems remain committed to the communities they serve, behavioral health is often an unprofitable service line. As a recent Behavioral Health Business article notes, it can be especially challenging for individual hospitals to negotiate appropriate reimbursement rates from health plans. Ultimately, patients in need of care face substantial delays, impacting both clinical outcomes and their overall satisfaction. 

For health systems without a behavioral health service line, the cost of services still exists. The lack of outpatient mental health care drives more patients to seek help in the emergency department, pressuring those already strained resources. The financial impact of boarding, increased staff for 1:1 observation, and loss of bed turnover can account for a direct loss of over $2,000 per patient.

The numbers in recent years are grim: 

• High ED utilization: 10.9% of ED visits are for psychiatric or substance use-related diagnoses.
• Limited providers: More than 60% of U.S. counties do not have a single psychiatrist.
• Delayed care: The national average wait time for mental health services is 48 days. 

So, where do we go from here? And what are strained health systems to do?

Opening the door for impact

The behavioral health crisis isn’t one for health systems to tackle alone. As with most aspects of our dynamic healthcare landscape, the best way forward is one where we walk together. We believe that behavioral health partnerships are key to addressing the growing needs of patient-centered care. Ideally, the right strategic partner can operate as an integral part of your network—reducing operating losses, improving quality outcomes, and boosting overall patient satisfaction.

By collaborating with a specialized partner, health systems can truly differentiate their system with standout benefits:

• Timely access: Prompt access to outpatient and follow-up care without any waitlists
• Integrated care: Seamless, two-directional data sharing for coordinated, in-step treatment
• Improved outcomes: The latest proven methodologies that enhance patient outcomes across the severity spectrum
• Scalability: On-demand scaling of provider capacity to meet patient demand efficiently

A recent case study 

At Brightside Health, we understand that each health system is unique. Our specialty is fostering synergistic collaborations tailored to your organization’s needs. We have a proven record of successful behavioral health partnerships with health systems and health plans alike, and several peer-reviewed studies detailing our outcomes in notable publications such as JMIR and BMC Psychiatry.

A recent analysis of a partnership involving over 20,000 patients yielded impressive results:

• Timely care: 86% of members received an initial appointment within 5 days.
• Clinical outcomes: 70% of members completing 12 weeks of care experienced remission. Half of these members faced moderately severe or severe depression and anxiety, with 34% reporting suicidal ideation at intake.
• Financial impact: We achieved an estimated savings of $24 million over two years.

Results like these are especially impactful among populations with comorbidities. Studies show the total cost of care can be 2.8–6.2 times greater for those with both behavioral and physical health conditions. 

That’s why we’ve ensured our virtual behavioral health services are accessible to as many people as possible. We treat individuals ages 13 and up with mild to severe concerns, and have specialized programs for elevated suicide risk and substance use disorder. Currently, over 130 million people have access to Brightside Health’s services, including those commercially insured as well as Medicare beneficiaries in all 50 states and Medicaid beneficiaries in a growing number of states. 

The way forward

Behavioral health partnerships represent a strategic opportunity for health systems to meet the growing demand for mental health services—and differentiate themselves with timely access and improved outcomes. By collaborating with a specialized partner, health systems can better serve their patients at all stages and become the cornerstone of mental health for their communities.

Together, we can enhance the behavioral health landscape in your community. Contact Brightside Health today to schedule your discovery consultation.

The post At a Crossroads: Behavioral Health & Overburdened Health Systems appeared first on Brightside.

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Through precision and personalization, we can do better. Knowing that the same condition can present with different and varied symptoms from one individual to another, we’ve made significant investments in technology and data science to improve accuracy in treatment selection and thus optimize clinical outcomes. Our providers use our proprietary clinical decision support system, PrecisionRx, to recommend the medication most likely to be tolerable and effective for a given individual.  

The precision approach 

Technology-enabled symptom-cluster analysis, along with our patient monitoring allows us to do better than guess and check. Instead of longer waiting periods after an initial prescription to check in with patients, our remote patient monitoring and communication capabilities surface  dozens of data points to providers before, during, and in-between visits. These data points help clinicians tailor their prescribing decisions to each individual—a practice we refer to as precision prescribing.

Our AI-driven decision support helps clinicians get each individual’s treatment right the first time. PrecisionRx analyzes over 100 data points about an individual to help personalize treatment plans: typical prescribing practices only support 13% of Brightside’s more than 1,000 medication/dose combinations. By using machine learning models to predict which medication will be most tolerable and effective for each patient, we can empower clinicians to make more informed treatment decisions across the diagnostic spectrum. This can also include patients with severe, complex, or acute conditions. 

At intake, 71% of our patients need help with three or more conditions, 75% come to us with severe or moderately severe depression, and 50% start with some passive suicidal ideation. 

How it works:

• When one of our psychiatric providers determines prescribing medication is appropriate, our proprietary PrecisionRx engine analyzes comprehensive clinical and demographic data and surfaces medication recommendations. 
• Taking into consideration a formulary that excludes all controlled substances, PrecisionRx helps our clinicians craft a personalized treatment plan.
• Measurement-based outcomes are fed back into our models for continuous improvement.

The results: 

In results published in the peer-reviewed journal BMC Psychiatry, our research team examined data from 6,248 Brightside Health patients receiving at least 12 weeks of treatment for depression and/or anxiety. Patients received a prescription for at least one psychiatric medication at the start of treatment. The study compared Patient Health Questionnaire-9 (PHQ-9) and GAD-7 scores at the start of treatment and again at two, four, six, eight, 10, and 12 weeks. 

After 12 weeks, 90% of study patients experienced clinically significant improvement, and 71% achieved remission. Further, 69.3% of those were on the same treatment they were prescribed at intake, while 30.7% required further iteration of their treatment plan to achieve remission. 

In short, PrecisionRx allows our clinicians to get it right the first time over 69% of the time — and intervene promptly to help the other 31%. In this way, we’re moving from guess-and-check prescribing to precision medicine. 

The post How Our Precision Prescribing Model Works appeared first on Brightside.

A question I’m often asked is, why don’t health systems just hire more providers or offer more telehealth appointments? If there’s that much demand for these services, can’t they just increase their capacity? Unfortunately, it’s not that simple. Health systems are limiting additional investment or even completely exiting things like behavioral health because, for many, it simply isn’t a strategic priority.

Additionally, with the increasing provider shortage, hiring more clinicians is a tall order — and even if it were possible, it wouldn’t enable health systems to cover gaps in care the way specialized telehealth providers can. Companies delivering this type of care offer far more than online visits — they present an entirely new care experience built atop technology that enables continuous monitoring, clinician interaction, and AI-based clinical decision support and intervention. So the real question is, how do we seamlessly integrate innovative, scalable treatment models into the patient flow of our country’s health systems? How can we use specialized telehealth providers to augment a health system’s capacity to better serve their patients without requiring incremental investment?

The answer is collaboration.

Health systems can’t — and shouldn’t have to — do it all. We’re at an inflection point where the old and new systems must collaborate to create a unified ecosystem rather than competing against each other. Patients are sitting on long wait lists, unable to get the care they need or the high-quality experience they deserve. We must align the opportunities and benefits of specialized telehealth with the strength of existing health systems to drive down costs and address these needs.

How Telehealth Collaboration Should Look

To discuss how collaboration between health systems and specialized telehealth should play out, we must reframe how we view telehealth and its role in delivering whole-person care at scale. It’s important to recognize that telehealth is not just an online visit between a patient and a provider; it is technology-enabled healthcare delivered virtually.

This is an important distinction, as specialized telehealth solutions do far more than provide virtual appointments–they deliver additional resources to providers and patients during appointments and the critical moments between them. If the explosion of telehealth during the pandemic taught us anything, it’s that the old model of infrequent in-office visits is no longer viable. Instead, patients want immediate care and access to their providers between sessions. In fact, to achieve better outcomes, patients need both continuous monitoring and real-time care management.

While health systems are great at many things, building this kind of technology is not often one of them. Instead, health systems should look to integrate specialized telehealth into their patient flows, choosing strong, tech-enabled collaborators who are already covering our country’s widest gaps in care. These specialized collaborators can more effectively and efficiently treat complex conditions by allowing patients to interact with the platform and their clinician between appointments. At the same time, clinicians can responsively intervene to deliver care when needed.

Simply put, collaboration enables a level of proactive and specialized care that health systems cannot achieve alone. But quality is key. Health systems considering collaboration should be willing to ask difficult questions regarding quality, safety, and outcomes. Specialized telehealth companies are uniquely positioned with a wealth of data at their fingertips, and they can and should use that data to continuously improve care delivery. These outcomes shouldn’t just be visible on company websites; they should be published in peer-reviewed journals. You should also expect telehealth providers to follow industry best practices and standards, such as completing HITRUST certification. Finally, it’s important that your collaborator can support your payer mix through direct contracts or through subcontracting with you.

Working Together to Solve Complex Problems

This model of collaboration is well-suited for solving complex problems in resource-constrained fields of care. Mental health care is an excellent use case. As health systems contend with months-long psychiatric wait times, telepsychiatric care platforms can ease the pressure. The issue of provider shortages is critical as the effects spill over into the emergency department (ED). While 62% of EDs lack psychiatric services to manage patients in crisis, the ED still triages psychiatric needs for those who don’t know where else to go. These patients take three times longer than average to move out of the ED and on to appropriate care. Inefficiencies in triage, evaluation and care are contributing to overcrowding, fewer bed turns, reduced scores on HEDIS measures, and an altogether untenable situation for health systems and hospitals.

Telehealth alone can’t solve this crisis, but we can make much more meaningful progress on these persistent challenges by working together. For example, integration with a telepsychiatry solution would allow treating larger patient panel sizes without compromising care quality. In addition, it would provide the ability to triage those with urgent needs and provide effective treatment — particularly for more severe and acute presentations such as suicidal ideation. This also makes specialized telehealth a viable referral pathway for step-down services for post-acute care. Finally, closer integration means a better experience for providers, who can confidently refer patients to specialized care quickly while maintaining visibility into patient care through a robust data-sharing loop.

Mental healthcare isn’t the only field that can benefit from this loop. For example, there is a parallel use case in chronic disease management. Together with mental illness, chronic diseases comprise 90% of the US’s $4.1 trillion in annual healthcare spending. In spite of this enormous yearly investment, health outcomes in this area remain abysmal. Specialized telehealth solutions can provide more comprehensive care for certain patients, especially those at higher levels of severity and acuity.

Of course, these two use cases are connected: there is a high incidence of chronic comorbidities among mental health patients, and mental health issues make it more difficult to manage those comorbidities. By collaborating with specialized telemental health partners, health systems around the country can deliver better outcomes for patients with mental health concerns, chronic diseases, and across populations, all while lowering costs.

Embracing the Next Phase of Evolution

Health systems have deeply-rooted community ties, patient relationships, and an in-person presence that telehealth will never replace. But current care needs are stretching their capacity, resulting in long wait lists, dissatisfied patients, and unnecessary emergency department visits. At the same time, the innovations of specialized telehealth are already driving big shifts in US healthcare. Collaboration offers health systems the opportunity to co-create a unified ecosystem that will deliver improved access and outcomes, reduced costs, simplified patient navigation, and a better healthcare experience for all.

Written by Brad Kittredge, CEO and co-founder of Brightside Health

Brad Kittredge has spent over a decade pioneering evidence-based and consumer-driven health care solutions, including building the Product teams at 23andMe and Lantern. Inspired by the challenges of a close family member with lifelong depression, Brad’s mission is to ensure that everyone has access to life-changing mental health care with measurably better outcomes. He holds MPH, MBA, and Psychology degrees from the University of California, Berkeley.

This article originally appeared on Medium. 

The post Good News for Health Systems: You Don’t Have to Do It All appeared first on Brightside.

I’m the founder of a mental health company, and his situation still makes me feel scared. I know how hard it has been for him to get care, and I worry about his ability to find adequate support in time if his suicidal thoughts worsen into plans…

Read the full article in MedCity News.

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While nearly every other leading cause of death in the US has decreased in the past 50 years, the rate of suicide has doubled. About 130 people die by suicide each day–approximately 1 death every 11 minutes. It is the second leading cause of death in adults under the age of 45 and the third leading cause of death for young people–except for children aged 10–14, for whom it is the second leading cause. In 2019, 9% of high school students reported attempting suicide in the past 12 months. For every suicide death, 27 people report attempting suicide, and another 275 people seriously consider it. Numbers like these are a sobering reminder that crisis care in this country is not yet where it needs to be.

Unfortunately, there is a growing shortage of clinicians available to treat these high-risk people, which means people are going without care at the moment they need it most–a problem with catastrophic consequences. In addition, people at risk for suicide are more likely to visit an ER or have an inpatient hospitalization.

This is an ideal challenge for telehealth to address. Yet, while virtual mental health care has improved access for those with mild-to-moderate symptoms, nobody is delivering crisis care virtually. Why? Because delivering the level of care required to treat suicidal individuals at scale is complex and requires the highest level of clinical rigor, robust supporting technology, and a large dose of humanity–a tall order, but something we can and must deliver on to get timely and effective crisis care to more people.

The shortcomings of virtual care

Historically, virtual care solutions have not been equipped to treat those with suicidal intent. They often lack the structure, clinical protocols, and oversight necessary to provide safe, effective treatment to people with severe symptoms.

Even at Brightside Health–where we are able to successfully treat a high volume of patients with severe symptoms (half our patients start with suicidal ideation)–we historically referred people with imminent risk to in-person treatment and facilitated the transition as needed. But we’ve realized that by referring out people with suicidal intent, we are failing to support so many people in need — including those in rural areas without anywhere else to go, low-income populations, or members of predominantly Black or Hispanic communities that have limited access to mental health care and provider shortages. While treating suicidal ideation is important, there is more we can and must do for those with active suicidal intent.

The population left behind

About a year ago, I met an executive from one of the major suicide advocacy nonprofits at a conference. She is a passionate leader who lost a brother to suicide. And while she truly appreciated our commitment to safety, she expressed her frustration that patients with suicidal intent still have an extremely difficult time finding fast, effective care.

Think about it. It’s hard enough for people with non-urgent mental health needs to find access to care. More than 60% of counties in the United States do not have a single psychiatrist, and for those that do, the average wait time can be upwards of 25 days. On top of that, providers often shy away from treating people with suicidal intent, making these people feel like a burden–repeatedly turned away or passed from one provider to another. As a result, the people most in need of timely care often can’t get it.

Shortly after this conversation, I spoke with our Chief Medical Officer Mimi Winsberg, MD, who leads our clinical programs at Brightside Health. Dr. Winsberg is a Stanford-trained psychiatrist with over 25 years of experience and was previously the on-site psychiatrist at the Facebook Wellness Center. After a long conversation, we decided to rethink how we could support this population: With all the advancements we’d made, were we ready to develop a program to safely and effectively treat people with active suicide risk virtually?

The solution: Crisis Care with a proven clinical intervention

Working with our clinical leadership team and outside experts, Dr. Winsberg concluded that we could deliver crisis care in a virtual environment using Collaborative Assessment and Management of Suicidality (CAMS). This therapeutic framework helps patients understand and manage suicidal thoughts and behaviors, opening the door for Brightside Health to offer timely and effective treatment to people with active suicide risk.

With CAMS at its core, later this month, Brightside Health is launching Crisis Care–a program that enhances access to specialized care for individuals who are actively suicidal and/or have had a recent suicide attempt.

Everything we do at Brightside Health is evidence-adherent, and our upcoming Crisis Care program is no exception. We looked for the gold standard approach with proven results and found it in CAMS — one of a handful of evidence-based treatments recognized by the Joint Commission, the CDC, Zero Suicide, and the Surgeon General. Based on 30 years of ongoing clinical research and five randomized controlled trials, CAMS has proven to decrease suicide attempts and self-harm behaviors, and reduce suicidal ideation, in as few as 6 to 8 sessions.

Looking ahead with Crisis Care: What a virtual program entails

We’ve built our Crisis Care program around CAMS to enhance access to specialized care for people who are actively suicidal, have had a recent suicide attempt, require team-based care, or are in need of follow-up care after hospitalization.

Treatment delivery will be entirely virtual, using our telehealth platform to facilitate multiple and frequent touchpoints, weekly sessions with a therapist, remote patient monitoring, and provider messaging between sessions–as well as psychiatry services. It also removes many potential barriers for those with suicidal intent, such as garnering the motivation to leave home, traveling to the clinic, or taking time off work or other obligations to attend appointments between 9am and 5pm. Care is at people’s fingertips, with support every step of the way.

Crisis Care will serve individuals with intermediate acute risk, including those who are stepping down from a more intensive level of care, high utilizers of emergency services, and those at increased risk of readmission. This program will deliver medically necessary care to patients who are often excluded from outpatient treatment (both in-person OR telehealth) because of risk yet fall short of requiring emergency services or an inpatient psychiatric admission. The program will also provide continuity of care, which is critical for preventing adverse consequences post discharge.

At Brightside, we are committed to getting people the life-changing care they need to overcome suicidal thoughts. In addition to the call to arms we feel as a virtual mental health care provider, this is a personal mission, as two of our co-founders lost a parent to suicide. We look forward to updating you on Brightside Health’s Crisis Care program when it launches later this month.

Interested in learning more about how Brightside Health can help you offer life-changing mental health care, including for the most severe cases? Visit us at www.brightside.com/partnerships, or reach out directly at partnerships@brightside.com.

Article originally published on Medium.

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By Mimi Winsberg, M.D. 

In a recent groundbreaking paper in the journal Molecular Psychiatry, authors Joanna Moncreiff and colleagues debunked the theory (or myth) of depression as a chemical imbalance of serotonin, concluding in their meta analysis of related scientific literature: “There is no evidence of a connection between reduced serotonin levels or activity and depression.” 

The authors’ main finding is that depression is not the result of abnormalities in brain chemistry, particularly serotonin. And they cite evidence that the “serotonin myth” is not only believed by a large majority of the general public, but propagated by primary care physicians, some mental health practitioners, and much of the media. 

The findings have created a stir that is a bit like how I imagine those in the early 16th century reacted when they learned the world is not flat. It is forcing a whole constellation of people to switch their views of what drives people’s moods and actions. It also raises the question: Why did so many believe in a chemical imbalance theory of depression and for so long?

The link between brain chemicals and depression originated in the 1950s when doctors treating tuberculosis patients with Iproniazid observed that patients receiving the drug underwent a sudden and dramatic improvement in their mood symptoms. Separately, in 1954, another group of patients were prescribed the drug Raudixin to treat high blood pressure and they, in turn, experienced a sudden onset of depression; many also became suicidal.  

The relationship between drugs that affect neurochemicals and depression came into focus, and the “monoamine” hypothesis of depression was born. The hypothesis postulated that depressive symptoms are mediated through an imbalance of the dopamine, noradrenaline and serotonin systems. Since then, antidepressant drugs have become a mainstay of treatment for depressive disorders, though selective serotonin reuptake inhibitors (SSRIs) — medications known under the trade names Prozac, Zoloft and others – did not hit the market until the late 1980s.

Few drugs have generated as much hype as Prozac. One year after FDA approval of the SSRI, 2.5 million prescriptions were issued in the U.S., and by 2008 antidepressants were the third most common drug taken in America. Now, one in six Americans take antidepressants. Yet while we understand some aspects of antidepressants’ effects, many uncertainties remain.  

What has been certain for well over a decade is that the monoamine theory of depression is oversimplified at best. If researchers had to sum up the relationship of serotonin to depressive symptoms, the answer would be “it’s complicated.” And the question of how serotonin levels relate to depressive symptoms is a separate question from whether SSRIs actually help alleviate symptoms of depression. (In many instances, they do.) 

In fact, as the Molecular Psychiatry umbrella paper suggests, some changes in serotonin levels in depressed patients may be compensatory adaptations to antidepressants. So even though an initial likely effect of an SSRI is to make more serotonin available, in the long term, the brain and body may adapt to the SSRI by downregulating serotonin receptors and function.  

What do we understand about depression? A few things, as it turns out. Like the Molecular Psychiatry umbrella paper, it’s an “umbrella” diagnosis. Under the umbrella label of depression, patients can present – or appear –  in a large variety of ways with myriad symptoms. It’s what we call a “heterogenous” diagnosis.  

To qualify for the diagnosis, people must have one of two primary symptoms (depressed mood, or inability to enjoy activities that would otherwise bring pleasure) and at least five out of nine total symptoms. Many of these symptoms are bivalent – meaning they can present as one of two extremes. So a symptom of disrupted sleep might mean trouble falling asleep, or sleeping too much. Same is true for appetite.  

Tally the number of symptom permutations one can have and still be diagnosed as “depressed,” and we arrive well over 300! Two patients might both be depressed and look nothing alike, with one patient nervously pacing, unable to eat or sleep and considering suicide; and another overeating, sleeping too much, feeling tired with little energy, and unable to concentrate. The brain chemistry patterns of these two patients are likely different.  

At Brightside, we consider the particular symptom pattern that each patient presents with, and we take a precision approach to treatment. One increasing advantage of online therapy is that it is technology-enabled and can draw on and produce data to generate key insights about treatment. A psychiatrist’s key responsibility is to determine whether to prescribe medication, and if so which medication. With the application of data science and machine learning enabled pattern recognition, we help our doctors tailor their prescribing decisions to the individual and not to an umbrella diagnosis – a practice we refer to as precision prescribing. 

The widespread misconception of depression as a chemical imbalance may be less of a problem than the misconception of depression as a single disease, along with the prevalence of one-size-fits-all prescribing practices, in which millions of patients are prescribed an SSRI that may be suboptimal for their symptom presentation. For some patients with some symptoms, serotonin activity may play an important role. That role may be less about increasing available serotonin and more about stimulating the formation of new brain cells that use serotonin to communicate with one another. 

Because the Molecular Psychiatry review paper has put all of depression under one umbrella as if it is a single disorder, it is not surprising that no simple and uniform biological findings emerge – and no obvious “solutions.” No reputable psychiatrist would ever have recently suggested that a heterogeneous condition like depression be attributed strictly to a deficit of serotonin, yet the paper has sparked articles in the mainstream press that uniformly decry the use of SSRIs and lots of “I told you so” chatter on social media. 

We must be careful in our understanding of this paper, which did not look into the effectiveness of antidepressants, but sought instead to uncover serotonin changes in depression. It’s the equivalent of studying all people who have a problem with their legs and classifying them with a walking disorder. Depending on the cause of the disability, underlying biology and effective treatment might vary. 

But what’s interesting about Dr. Moncreiff and colleagues’ work is that it may propel a step forward in the understanding and treatment of depression. It will challenge the primary care physicians and therapists who utter the words “You have a brain chemical imbalance” and suggest an SSRI without consideration or further analysis of specific symptoms.   

Indeed, we are on the forefront of a better understanding of biological as well as psychosocial models of depressive symptoms. Brain scans and tissue studies have shown that chronic and repeated stress and major depression are associated with changes in the brain, such as loss of connection between neurons. Some of these changes can be seen as a loss of brain volume in key areas of the brain involved in mood regulation. 

Whether mediated by antidepressants or therapy, the path to healing likely involves enhancing synaptic connections between brain cells. With the advances of science and technology, I believe we may witness not just breakthrough technologies to treat depression but breakthrough understandings that come from the implementation of these treatments.

Interested in learning more about how Brightside Health can help you offer life-changing mental health care, including for the most severe cases? Visit us at www.brightside.com/partnerships, or reach out directly at partnerships@brightside.com.

Originally published in The San Francisco Examiner

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One in five adults in the U.S. lives with a mental illness. Rates of anxiety, depression, and suicidal thoughts are skyrocketing, and more than half of adults with a mental health condition don’t receive treatment at all. With statistics like these, there’s no denying our country is facing a serious mental health crisis.

While a myriad of telemental health care solutions have come to market, most have simply moved offline care online. And while this increases access for those with less severe symptoms, it does little to address more severe cases. As a result, people with more complex needs are often treated ineffectively, or turned away altogether by virtual services that lack the clinical sophistication and rigor these patients need — potentially causing more harm than good. Simply put, that’s just not good enough. To address our country’s mental health crisis, we must efficiently and effectively treat people with the most severe and complex cases, and acute needs, at scale.

This requires making significant improvements to the way mental health care is delivered virtually. Through the targeted application of data science and technology, deep human connection, and making care affordable, we can not only save more lives, we can materially reduce the cost of treating the patients who are most in need, and who drive the majority of mental health care costs.

Empowering clinicians with insights for greater impact

By its nature, virtual mental health care is technology-enabled. Like other industries that have moved online, there is an opportunity to utilize the rich data generated in digital interactions to generate key insights that drive superior outcomes throughout the customer (patient) journey.

Precision prescribing

The prescribing decision is one phase of that journey that is ripe for innovation. One of a psychiatric provider’s most sacred responsibilities is to determine whether or not to prescribe, and which medication/s to select. Here, we can use data science to help clinicians tailor their prescribing decision to each individual — a practice we refer to as precision prescribing.

Due to the prevalence of one-size-fits-all prescribing practices, millions of people are on suboptimal treatment plans for mood disorders, or have stopped treatment altogether due to side effects, lack of response to the medication, or both. As shown in the widely-known STAR*D trial, prescribing any given antidepressant achieves a response in only 35% of the population. As a result, way too many people receive ineffective treatment — often leading them to stop care altogether. This guess-and-check approach to psychiatry isn’t good enough when people’s lives are at stake.

AI-driven decision support can be a much better alternative, helping clinicians get each individual’s treatment right the first time. By utilizing machine learning models to predict which medication will be most tolerable and effective for each patient, we can empower clinicians to make more informed treatment decisions and more effectively care for a larger portion of the population.

At Brightside Health, this is particularly important, as 71% of our patients need help with three or more conditions, 75% come to us with severe or moderately severe depression, and 50% start with suicidal ideation.

When one of our psychiatric providers determines prescribing medication is appropriate, we use our proprietary PrecisionRx engine to analyze comprehensive clinical and demographic data and surface individually-targeted medication recommendations. Taking into consideration over 1,000 medication/dose combinations from a formulary that excludes all controlled substances, PrecisionRx helps our clinicians craft a personalized treatment plan, resulting in a 70% response rate to the first medication prescribed. Since we monitor all of our patients very closely, we promptly intervene with the other 30%, adjusting dosage and/or medications appropriately. The impact of treatment adjustments and outcomes is fed back into our models for continuous improvement.

Proactive, timely intervention

Another compelling opportunity is to apply data science to the copious amounts of data generated from online check-ins, messaging, and other forms of remote monitoring to assess a patient’s progress and identify risk levels in near-real-time. Using these insights is a novel way to enable proactive, timely intervention — increasing patient engagement and saving lives.

Whether the PHQ-9, GAD-7, or another standardized measure is used, regular online check-ins are a core component of most virtual mental health care services; monitoring a patient’s score is a tried and true method of gauging the severity of their mood disorder. Digital messaging has also become table stakes and can be an effective way for patients and clinicians to communicate outside of an appointment. As helpful as these capabilities are, we can apply data science to make them even more useful — in this case by proactively identifying when a clinician should intervene with a patient.

For example, we can compare an individual’s progress on standardized measures against the predicted trajectory of that patient’s recovery, and when the actual falls short of the prediction, automatically alert the patient’s clinician to review their case. We can also utilize natural language processing (NLP) to evaluate messaging in near-real-time and automatically escalate risk to the patient’s clinician, ensuring prompt, proactive intervention.

When supported with these capabilities, patient adherence improves, and we can significantly increase the likelihood that clinicians have the right touchpoints at the right time, with each patient — particularly those with suicidal ideation.

At Brightside Health, we utilize these and similar technologies within our care model, enabling the efficient and effective treatment of severe and complex mood disorders. Within 12 weeks, our clinicians help 86% of patients experience clinically significant improvement (88% for those reporting suicidal ideation at intake), with 71% achieving remission (66% for those reporting suicidal ideation at intake). Of the patients achieving remission within 12 weeks, 65% did so within 28 days, and 82% did so within 48 days. The mean time to remission was 31 days (O’Callaghan et al., in press).

Our care model has also proven to deliver 50% higher rates of response and remission than top-ranked health systems are able to achieve with traditional care (Chokshi S, Senathirajah Y, Yadav V, et al., Cureus Journal of Medical Science). These outcomes enable us to materially reduce the cost of treating the patients who are most in need, and who drive the majority of mental health care costs.

The indisputable influence of human connection

While data science and other technologies can significantly enhance the delivery of mental health care, they cannot replace human connection in helping people get better — a strong therapeutic alliance leads to better adherence, engagement, and outcomes.

Since the onset of the COVID pandemic, telehealth has become the predominant way people receive mental health care services, making a clinician’s ability to form strong virtual relationships with their patients especially critical. Clinicians must be intentional about building personal connections so the technology doesn’t overshadow the humanity involved. In addition to training on strong webside manner, we must prioritize building a trusted, 1:1 relationship with each patient, and creating a safe environment that fosters open dialogue and drives regular engagement.

Could a provider see more individuals if a coordinator gated access or patients were passed among a pool of clinicians if coordinators led the way and patients were passed off between intermediaries? Potentially, but at what cost and to what end? Mental health care requires nuanced, supportive care and clinical judgment at every step, and patients should never experience gated access to their clinician.

At Brightside Health, we prioritize human connection and achieve it by ensuring one-to-one care from a licensed clinician from start to finish. Our patients see and have unlimited communication with the same clinician throughout their treatment, enabling them to build an alliance that yields both continuity of care and improved outcomes. This strong clinician-patient relationship — bolstered by comprehensive clinical protocols spanning supervision, case reviews, and ready access to escalation paths — ensures safe, effective treatment for even the most complex cases.

Integrating within the wider ecosystem for affordability

Virtual mental health care can be extremely effective, but offering great care alone is not enough; it must also be affordable. There are three main ways telemental health care companies are going to market today: cash pay, direct-to-employer, and working within the existing healthcare system. Of those options, working within the existing health care system is the only one that offers a low-friction and sustainable way to provide affordable, high-quality care to any population, through partnerships with each of the stakeholders that help people pay for and navigate care choices: payers, plan sponsors, providers, and partners/brokers. In addition to enabling greater access, these partnerships open the door to strategic population-based initiatives and create a reimbursement model that enables financial alignment for all parties involved.

We employ this integrated approach at Brightside Health, and we are proud to have earned national partnerships with Cigna, Aetna, and Optum. As a result, we are in-network for over 55 million people nationwide, with many additional payer partnerships on the horizon. Combined with our ability to treat even the most severe cases that account for the greatest expense, Brightside Health can uniquely help payers, providers, and plan sponsors reduce cost and improve outcomes in a way no other company can.

Going a step further: treatment for suicidal intent

While this virtual care model has helped Brightside Health successfully treat tens of thousands of individuals to date — a large portion of whom came to us on the higher end of the severity, complexity, and acuity spectrums — we still have work to do.

Suicidal ideation has increased every year since 2011, and suicide rates have increased 30% overall since 2000, with the last couple of years of the pandemic seeing a surge. People at risk for suicide are more likely to visit an ER or have an inpatient hospitalization, driving up the total cost of care for both patients and health systems. In parallel, there has been a growing shortage of clinicians available to treat these high-risk populations, resulting in both a significant unmet need and lives lost unnecessarily.

Fifty percent of our own members start treatment with suicidal ideation, and we are committed to offering programs that enable us to serve even the most vulnerable populations. With that in mind, later this year, Brightside Health will be launching the first virtual national program for proactively treating suicidal intent, based on the Collaborative Assessment and Management of Suicidality (CAMS) — a care model backed by 30 years of research and five randomized controlled trials. We’re eager to put what we’ve learned to use and become an even more effective solution for those most in need.

The bottom line: Saving lives and bringing accountability to mental health care

There’s no denying that telehealth has significantly improved access to mental health care, but it’s clear we have work to do to change the trajectory of the mental health crisis. We have a responsibility to provide care to higher-risk populations as effectively and sustainably as we do to those with lower levels of severity. This requires rethinking how mental health care is delivered in virtual settings to ensure a safe, effective solution for every individual no matter where they fall on the severity, complexity, and acuity spectrums. When we can help even the most severe cases we can significantly reduce avoidable healthcare costs for individuals, health plans, and health systems — and more importantly leave a lasting, life-changing impact on the lives of those who need it the most.

Article originally published on Medium.

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