- More than 14 million adults in the United States have a severe mental illness (SMI), which affects how they feel, think, and behave. Few receive quality care.
- The driving force behind mental health medications and treatment plans is qualitative, not quantitative, unlike the vast majority of medical specialities. Meanwhile, the most significant innovation in healthcare delivery over the last half-century—telemedicine—has done little to boost care for people with SMI.
- Standardizing data collection will eliminate guesswork when it comes to treating patients with SMI, and revamping in-person care gives patients the lifesaving support they need.
KEY INSIGHTS:
Despite more than 14 million adults in the U.S. suffering from severe mental illness (SMI)—like major depression, schizophrenia, or bipolar disorder—little has changed in terms of how we treat these individuals in decades. Quality mental healthcare could help them live healthy, fulfilling lives, but too many can’t access care, or receive inadequate care at best. Two advancements, which are accepted in many other medical specialties, can revolutionize the treatment of SMI: prioritizing in-person care and implementing extensive, standardized data collection and analysis.
A complex web of factors drives the profound lack of care for people with SMI. For starters, patients often deny they’re sick at all, making it extremely difficult to get them the help they need in the first place. Those who do seek care face an invisible hurdle: Current SMI treatments are driven by each individual clinician’s skill set and experience, not hard data. Today, decisions about which medication and dosage to prescribe are almost entirely trial and error. Given that side effects can be so brutal, and taking the wrong medication can be so emotionally debilitating, patients often stop taking their medication altogether.
Meanwhile, many people with SMI push away family and friends, leading to higher rates of social isolation and loneliness—and, as a result, more frequent psychotic symptoms. People with SMI are 50% more likely to use illicit drugs. They are also about 12 times more likely to die by suicide than the general population. Psychiatric care, a critical part of SMI care, is often geographically inaccessible and unaffordable. Before the pandemic, only 55% of psychiatrists accepted private insurance, compared with 89% of physicians in other specialties.
What’s more, the most significant change in healthcare delivery over the last half-century—enhanced access via telehealth—has done little to boost care for people with SMI. Just imagine holding a group therapy session via Zoom for nine people experiencing psychosis; it may be better than nothing, but the complexities of people with SMI are often not best treated virtually. Online, clinicians are unable to make key observations, like whether a patient smells like marijuana or alcohol, has body odor from not showering, or is experiencing dyskinesia. Telehealth denies clinicians the opportunity to collect data needed to provide better, more specialized treatment. It robs them of the chance to administer long-acting antipsychotics on site, which are the gold standard in care. It also removes the opportunity to build a stronger therapeutic alliance with patients on an in-person level. Finally, many people with SMI feel paranoid around technology, putting telehealth almost certainly out of reach.
Living with severe mental illness doesn’t have to be this way. Standardizing data collection and revamping in-person care are key missing links to successfully treating patients with SMI.
“Standardizing data collection and revamping in-person care are key missing links to successfully treating patients with SMI.”
Data can turn gut instinct into a systematic approach for treating patients with SMI
Most medical specialties follow clear treatment plans developed with years of data and study. There are ever more sophisticated algorithms predicting risks of cardiovascular disease based on measurable factors like age, sex, blood pressure, and lipid profile that guide treatment decisions with precision.
The brain is far more complex. Research on severe mental illness has long lagged behind other medical specialties because it’s so difficult to quantify. Most researchers are based at academic medical centers, where the clinical care for SMI patients is often short-term in nature. Yet longitudinal studies require continuous data and monitoring over many years. Not all psychiatrists on the front lines use measurement-based care, and when they do, they’re often collecting basic information using PHQ9 or GAD7 questionnaires. Data-informed protocols simply don’t exist in mental health—yet.
We need to bridge the gap between data-driven medicine and face-to-face interactions in mental health. How? By turning psychiatrists’ gut instinct into a centralized data platform that can provide evidence-based guidance about what medications to prescribe when, foster better drug development, improve treatment protocols, and reach patients across the country. At Amae Health, our patients see their personalized, multidisciplinary care team—typically including psychiatrists, therapists, dietitians, health coaches, member support specialists, peer support, and primary care—approximately 500-plus hours in the first year, over many years. This sustained engagement provides ample opportunity to collect longitudinal data in a way that’s never been done before. We combine historical medical data, labs, actigraphy data from wearables, genomics, claims records, pharmacy data, and speech data with our own interactions with patients. Our AI engineers and data scientists train on this data to piece together what’s possible in terms of data-informed precision medicine approaches to psychiatry.
For instance, sleep and daily activity data from fitness trackers may be able to predict worsening mental and physical health symptoms before an individual is even aware. This ability to detect and treat symptoms early would allow for lower-risk interventions, such as cognitive behavioral therapy instead of a new medication. And it may prevent mental health crises that require more resources to manage, including inpatient hospitalization.
Data might also show, for example, that lithium stops working well after a year for 25- to 35-year-olds who have a certain genomic variant. An insight like this would enable psychiatrists to proactively switch patients to another, better suited drug.
Or, data could reveal that it takes some patients only 72 hours to tell whether an antidepressant is working, instead of the current six-week time frame that’s based on a single clinical trial done many years ago. By gathering longitudinal data on Amae members’ health outcomes—across diagnoses, medical records, labs, current treatment plans, and more—our centralized AI platform, built on top of Palantir, enables our clinicians to create personalized care plans and treat with more accuracy. Of course, developing this baseline will take time, but we hope to continuously design precision medicine tools for Amae’s providers to further improve the quality of care we deliver.
“By gathering longitudinal data on Amae members’ health outcomes—across diagnoses, medical records, labs, current treatment plans, and more—our centralized AI platform, built on top of Palantir, enables our clinicians to create personalized care plans and treat with more accuracy.”
In-person care makes the difference
When it comes to care for SMI, data innovation must go hand-in-hand with in-person care. Research shows that positive, productive relationships between patients and clinicians lead to better outcomes. In-person interactions are fundamental to building this trusted relationship.
From the moment someone walks into one of our clinics, they’re matched with a team offering best-in-class care. A psychiatrist is the patient’s team leader and formulates treatment plans alongside the rest of the multidisciplinary team. They can also treat patients with long-acting antipsychotics that last up to 90 days, which decrease debilitating side effects and boost adherence compared to oral medication. Holistic health coaches and dietitians help patients take control of their wellbeing by setting health goals and creating action plans. Our therapists are trained in cognitive behavioral therapy and dialectical behavior therapy modalities and provide both individual and group therapy to our members. Primary care doctors focus on patients’ physical health and comorbidities, and our peers provide patients with life skills and hope that one day their own lives will regain meaning and purpose.
Effectively treating people with severe mental illness has always been a jigsaw puzzle, but improving data collection—and combining it with high-quality in-person care—will eliminate guesswork, overhaul future drug development, and dramatically improve patients’ lives.
