Three Concentric Circles2023-03-19

The future is already here- it’s just not evenly distributed.

William Gibson

Mental healthcare is currently suboptimal, with diagnosis relying on self- report of feelings and thoughts, recollection of events by patients, and clinical impression of the clinician. Treatment is not directed by biological lab tests, and it is often trial and error. Clinicians are generally dedicated and hardworking individuals, but have to rely on an antiquated approach, that has not improved in decades.

If nothing is done, things will get even worse with the spiraling healthcare costs, the socio-economic disruptions that started during the COVID pandemic, and the growing impact of addictions- digital addictions in children, fentanyl in those who are older. Suicides are increasing, especially in the young.

We should collectively do something about it now, using existing but under-deployed resources, while awaiting new technology to be rolled out at scale in the years ahead.

It could be done with three concentric circles.

First of all, the outside circle is a better, more precise assessment of the clinical picture and history. Quantitative scales should be used at the time of appointment, and at home in between appointments. Digital technology has made that eminently feasible. There are many tools out there. One we have created an app called Life x Mind that can be used at home, and at the time of the appointment, to provide nice quantitative graphs for feelings, thoughts, past history. Makes life easy for patients and clinicians. Sort of a Fitbit for the Mind.

The second circle is using laboratory tests to help with diagnosis and treatment choices. Mental health is pretty much the only specialty that does not do that routinely. There are DNA tests developed by many others that inform whether the patient is a fast or slow metabolizer. There are RNA tests developed by us that can objectively assess disease severity, response to treatment, and match people to medications in a personalized way.

The third, inner circle, is treatment. Nutraceuticals and medications should be used in a personalized way based on clinical factors and blood tests, and pill-packs provided to patients with the personalized combination to take daily, to make it easy and insure compliance.

Each of these advances is a small step for medicine, but a big step for the field of mental health. All these advances are here, they just need to be deployed faster where they can have the biggest impact. Primary care providers see the majority of mental health issues initially, and are used to using such tools for their full physical work-up. Primary care, then, is the place where such tools should be deployed first, and become part of preventive approaches.

Live. Happier. Longer.