What’s Next in Behavioral Health
By Barry Sarvet, M.D.
As a science-fiction fan, I would love to be able to travel in time to see into the future of psychiatry. But, of course, the future isn’t really knowable and depends in large part on the choices we make. A more useful and realistic approach is for us to envision a possible future based on our awareness of the most urgent needs in the field, and to assume linear progress from the current state of our scientific knowledge and discovery.
In my opinion, the two most compelling needs within the field of psychiatry are the need for more effective, safe, and reliable treatments for the subset of psychiatric patients who don’t respond optimally to current treatments, and the need to make psychiatric care more accessible and equitable for everyone who suffers from mental-health conditions.
Depression is one of the most common psychiatric illnesses, affecting 7.1% of all adults and 13.3% of adolescents in the U.S. Severe depression is a potentially deadly illness, and suicide is a leading cause of death in this country. Although we already have a host of effective treatments for depression, between 10% and 30% of patients do not respond favorably to treatment. However, ongoing advances in our understanding of the neurobiology of mental illnesses in recent years have led to a number of novel biological treatments for treatment-resistant depression and other psychiatric conditions.
“Ongoing advances in our understanding of the neurobiology of mental illnesses in recent years have led to a number of novel biological treatments for treatment-resistant depression and other psychiatric conditions.”
One recently developed treatment that has shown great promise with treatment-resistant depression is repetitive transcranial magnetic stimulation (rTMS). Available at Baystate, rTMS is a non-invasive procedure in which focused pulses of electromagnetic energy are applied to specific regions of the brain resulting in increases in blood flow and metabolic activity. rTMS belongs to a branch of psychiatric treatment referred to as psychiatric neuromodulation. We expect to see further development of this branch in coming years, particularly because of the encouraging observations of clinical effectiveness and safety of this type of treatment for patients whose conditions have not responded to conventional medications.
Other biological psychiatry advancements on the horizon include the development of medications targeting receptors for neurotransmitter systems (such as glutamate and NMDA) which have recently been implicated in the pathophysiology of depression and other psychiatric illnesses. We are also seeing a renaissance of research activity studying the use of so-called psychedelic drugs in combination with talk therapy to induce states of consciousness in which patients may find it easier to change well-worn patterns of thinking associated with psychiatric illnesses such as PTSD, anxiety, and depression.
Lastly, on the biological front, advances in the understanding of genetic variability in metabolism and responsiveness of the nervous system to psychiatric medications promise to usher in an era of personalized medicine in psychiatry, allowing psychiatric clinicians to select effective and tolerable medication treatments for patients without having to go through a trial-and-error process.
Even more important than advances in biological psychiatry is the need for progress in making psychiatric treatment more accessible to everyone who needs it. Currently, a majority of patients with mental illness do not receive any treatment at all, and for many more, treatment is delayed. In fact, many patients with untreated mental illness, disproportionately persons of color, end up in the criminal-justice system because of a lack of access to care.
In recent years, we have seen steady reduction in stigma surrounding mental illness and increased acknowledgment of the importance of mental health across society. Baystate’s recently announced plan for the development of a new, state-of-the-art psychiatric hospital facility for our region reflects the growing recognition of the importance of improving access to behavioral healthcare.
This new facility is just one component of a comprehensive strategy which needs to be executed in partnership with the whole community to improve access to all levels of mental healthcare and address persistent racial and socioeconomic disparities in access to care. Some of the components of this strategy includes work we have been doing at Baystate to embed mental-health services into our primary-care services. In addition, our development of new training programs for psychiatrists and child and adolescent psychiatrists have established a pipeline for enhancing the psychiatric workforce in our region.
We also will see continued use and improvement in telehealth models of psychiatric practice, which, of course, have dramatically grown in response to the pandemic, and have proven to be an important tool in reducing geographic barriers to access to care.
Dr. Barry Sarvet chairs the Department of Psychiatry at Baystate Health.