Commentary — February 2018
Tex Med. 2018;114(2):4.
By James G. Baker, MD, MBA
It is far too common in psychiatry for diagnosis to first come in a crisis visit to the emergency department, the equivalent of diabetes being first diagnosed as ketoacidosis. That is why I am very persuaded by the argument that we should focus on early detection and treatment in mental health, just as in other medical specialties.
What if our medical association and our local medical societies took the lead in the development and implementation of strategic population mental health initiatives across the state focused on early detection and intervention of mental illnesses? Our shared vision could be a statewide population mental health initiative with four parts:
- Routine screening for depression, anxiety, and post-traumatic stress as a part of every outpatient clinic visit in Texas. Mental health screening could ― and should! ― be just as routine as temperature, pulse, and blood pressure screens for every adult in Texas, whether care is provided in the public or private sector. As an example, The University of Texas Southwestern’s Madhukar Trivedi, MD, has an iPad software program, VitalSIgn6, that screens for depression and can be modified to screen for other common mental health challenges.
- Routine substance-use screening as part of physical exams for every teenager and adult in Texas. The NIDA Modified Assist (for adults) and the CRAFFT (for adolescents) are examples of quick, easy-to-use screening tools. Significant reductions in alcohol and substance use can result when screening is followed by a nurse or social worker offering brief, evidence-based intervention at the same doctor visit.
- Easy access to evidence-based, first-episode psychosis treatment and research protocol for every newly diagnosed patients in Texas. Early and aggressive treatment in programs like RA1SE have been shown to improve markedly the outcome of patients with schizophrenia and other psychiatric disorders that include psychotic symptoms. Its availability currently is limited, but detection and early treatment are just as important with schizophrenia as they are with cancer.
- Easy access to mental health first-aid training for everyone in Texas. Mental Health First Aid is a training course started in Australia 15 years ago that is now available statewide for anyone in the community, including first responders. The training reduces stigma, and, just like CPR, Mental Health First Aid has the potential to save lives. Our goal could be to train 750,000 people statewide.
Perhaps our medical association and local medical societies could partner with medical school departments of psychiatry, with local mental health authorities, and with local and statewide philanthropic organizations to demonstrate quick and quantifiable success in our four-part, population mental health initiative. Armed with that data, we could approach policymakers with strategies to improve access and quality of mental-health and substance-use services to everyone in our state, especially to the poor.
The potential impact on our patients and our communities ― and on each one of us ― is huge. As a mother, father, son, or daughter, you are just as likely to have family affected by mental health as by cancer ― up to one in three Texans has a mental health and/or substance use disorder. As a taxpayer, you help fund at least $1.4 billion in emergency department costs from mental illnesses presenting in crisis.
Each of us now knows that mental illness is medical illness, just like diabetes, cancer, or cardiovascular illness. And each of us knows that contemporary mental health care is rooted in science. Next, we must insist upon prevention, early intervention, and aggressive treatment for people who endure these potentially devastating disorders. When all that is required for early detection is a couple of questions asked while taking a pulse, then collectively we must insist that those questions get asked.
James G. Baker, MD, MBA, is a member of the Texas Medical Association Council on Science and Public Health. He also serves as associate chair of clinical integration and services in the Department of Psychiatry at The University of Texas at Austin Dell Medical School and as systems chief medical officer for integral care, the community mental health center for Austin and Travis County. Dr. Baker is a Distinguished Life Fellow of the American Psychiatric Association and a recipient of the National Alliance for the Mentally Ill Exemplary Psychiatrist Award as well as the Mental Health America of Greater Dallas Pamela Blumenthal Memorial Award.