Our Theory of Change
As golden leaves begin to fall in many parts of the country and the afternoon light starts to wane, it dawns on me that for a second consecutive year, a Covid-marred holiday season is nearly upon us. The end of the year is indeed a time of reflection, offering an opportunity to consider what has changed and what has stayed the same.
The world has battled a global pandemic in 2021 and over the course of the year, there have been miracles of science and glimmers of hope that life might one day soon return to normal. There has also been a persistent parallel crisis: the worsening mental health of so many.
Before the pandemic, the American Psychological Association and other leading organizations called attention to the rapid increase over the course of the 2010s in patients suffering from mental health issues. The Anxiety and Depression Association of America noted that anxiety disorders affected 40 million adults in the U.S. (18.1%) each year. However, data from the CDC indicates that more than 1 in 5 Americans over 18 years old took prescription medication for mental illness in the last month alone.
On October 10, the World Health Organization continued efforts to raise awareness through World Mental Health Day. Televised football games featured public service advertisements starring prominent athletes coming forward to discuss the importance of tackling stress, anxiety, and depression. Olympians, tennis stars, and basketball players alike are prioritizing all aspects of their health now and the impact of their example cannot be understated.
Against this backdrop, I have been thinking about my own journey, as a founder of a company building software for mental health providers. Six months ago, as my team was coming together, I started to notice a pattern. “I understand that you want to start by building applications for psychiatry departments,” people would share. “But how is psychiatric care different from other specialties?”
While there has been a great deal of attention paid to de-stigmatizing mental health, there has been far less focus on listening and learning from those who help us when we need a diagnosis or referral, therapy or medication management. Few understand what would help professionals treating people seeking mental healthcare, let alone the types of organizations that employ these experts.
This underscores the importance of an organization’s “theory of change.” At Dr. Katz, we believe that progress is made tangible when the largest health systems meet their fullest potential. We believe that people working in these systems deserve to be listened to and made an active part of designing a better way forward.
We have done a lot of listening this year and among other things, we have learned that psychiatric care encompasses a wide range of services, from social work to group support, couples therapy, coaching, counseling, clinical psychology, psychiatry, prescription medication management and more, across a vast landscape of subspecialties, from anxiety to eating disorders, substance use and Alzheimer’s. It’s hard for any one professional to become an expert at each treatment approach for every patient. But if organizations are to offer high-quality, easily accessible, personalized mental health care, we have to start by building a system through which professional development and skills-based training is a priority.
Based on what we have heard, busy mental health professionals, overwhelmed by demand for their services, want help staying organized, connected, and calm. Yet they are also avid, collegial learners with voracious appetites for keeping up with the latest best practices in an ever-changing, and still relatively new field.
As has been demonstrated in other work spaces, change is coming through technology-enabled solutions. Collaborative software and distributed computing can enable institutions to make better use of their educational, clinical, and research capabilities. By scaling up and out their learnings, providers can adopt best practices more quickly, create more robust networks, and close the “care gap” by treating all who need help. Networked care also will give rise to breakthrough discoveries, in just the same way that networks enabled the astoundingly swift development of multiple, effective Covid-19 vaccines.
While everyone should benefit from a system that incentivizes knowledge acquisition, large, academically-affiliated hospitals and health systems have the educational, clinical, and research components that call out for integrated software solutions.
Psychiatric care is highly specialized and difficult to coordinate
In the United States, mental healthcare services are delivered in a fragmented manner. The 700,000 professionals involved in this critical activity differ in training, credentials, and authority. Their workspaces take many different forms, and are often not ideally suited to either care provider or patient. As these professionals go about their work, they face significant obstacles both in learning from others and sharing their own knowledge.
Psychiatrists, as M.D’s, can prescribe medications and treatment plans. They will often be affiliated with large hospitals, health systems, and psychiatric hospitals, who need them on staff. But for economic and personal reasons, many of these professionals also maintain private practices. These multifarious work situations make the sharing of best practices a multi-dimensional problem: who determines solutions, how are they shared rapidly and effectively, how can feedback be best obtained, who is responsible for quality control, as well as economic and record-keeping issues are generally recognized as unsolved issues by most in the field.
At the same time, psychiatrists are aging out of the workforce, even as demand is growing. Moreover, science is proceeding at an accelerating pace to deliver a more refined understanding of many disorders, and to bring new treatments to bear. Collaborative software is essential to the critical task of providing assistance to providers with increasingly specialized skill sets.
Psychiatric nurses, psychologists, counselors, social workers, and other types of care providers also work in a mystifyingly complex variety of settings. Hospitals, outpatient clinics, community health centers, and private practices are some of the categories, and in each of those, numerous variations exist. Across these different forms of care delivery, inefficiency abounds.
This system is not so much partitioned as it is shattered. It cries out for a unifying, coordinating technology-enabled solution. With so many people now seeking mental health care, the imperative for change is clear. A hospital administrator recently told me:
We have such demand for our services. In the absence of adequate staffing [nationwide], there is a shortage of 12,000–14,000 psychiatrists and 35,000 psychologists. This forces departments to develop a platform that increases the efficiency and ability, in a more nimble and cost-effective way, to scale.
By focusing on psychiatric care, we have the ability to demonstrate deep understanding of the workflows most important and pain points most persistent for providers who operate in a unique care environment.
Building a learning community
From an educational standpoint, we have learned that the clinical thought leaders relevant to both caregivers and patients will vary significantly by subspecialty. However, the top organizations, primary associations, and seminal individual researchers are known and recognized by peers. The challenge is the absence of a centralized resource library and a simple way to encourage learning across organizational boundaries.
Furthermore, we have learned that the licensing bodies, state boards, and professional, interest, and affiliate organizations included in the medical regulatory regime also vary widely based on specialization. Portability of licenses and credentials is a major obstacle for providing continuous care of patients across borders, especially as expectations around mobility increase.
In psychiatric care, the variety of roles, novelty, and range of subspecialties adds complexity less present in other medical fields. The variety of treatment modalities and procedures, from cognitive behavioral therapy and group support via telemedicine, to ketamine-assisted therapy and medication management — adds still more complexity since licensure and compliance requirements that must be met by providers is so varied.
Bringing collaboration into patient care
From a clinical standpoint, catering to mental health providers means building a platform that can facilitate and assist in a special variety of treatment delivery modalities. Unlike some specialties, psychiatric services can be delivered effectively in-person, through virtual visits (eg. video, messaging), and via self-guided experiences (eg. virtual/immersive reality, journaling, psycho-education). Services span both inpatient and outpatient settings and may involve the coordination of multiple caregivers. They may include administration of various types of therapeutics. Therapy may be conducted one-on-one (eg. psychotherapy), with couples (eg. marriage, family counseling), or in groups (eg. postpartum, addiction recovery). There can be urgent needs for expert consultations and crisis hotline escalations.
As these treatments are administered, technology should advance psychiatric care quality standardization through patient-reported outcomes and measurements specific to mental health. Both providers, as well as researchers, are interested in harvesting a combination of passive and self-reported data from patients and clinical trial participants via connected devices and simple assessment instruments. But this data, from heart rate to information about sleep, exercise, diet, as well as self-reported data surrounding condition symptoms and medication adherence has yet to be organized, made machine readable and uniformly available to mental health caregivers.
Traditional medication management practices, which includes “charting” using legacy electronic health record systems, have thus far failed to improve patient outcomes in mental health. For too many of us, this is personal and we know one or more friends and family members who have struggled recently with their mental health. The future of healthcare is in digitally-connected services that weave research and education into clinical practice. By proving this model in psychiatric care and staying focused on the expansive opportunity to deliver a unified solution for providers in this specialty, we stay true to our theory of change and determined to improve the delivery of mental healthcare.
We believe:
- Clinician education is the foundation for high-quality mental health
- Giving patients and caregivers access to educational information is a critical part of therapy
- Regular, reliable engagement with patients fosters the most growth
- Patients see more positive outcomes when clinicians practice measurement-based care
- Health systems that embrace best practices will revolutionize patient care
Finally, we believe that collaboration with leading health systems and individual end users is the only way to design a solution that people will want to use. If you’d like to learn more, please sign up for our mailing list and drop us a note.
