Affordable healthcare for the people of our nation is facing challenges, in particular mental healthcare. This issue is important to me, as I live with schizophrenia—and I believe the cost and suffering of mental illness form our nation’s most salient issue today. Mental health conditions afflict 1 in 5 Americans, and do not discriminate by ethnicity, ideology, or any other demographic. Because of mental illness’ prevalence, its early start–roughly 3/4 of mental health conditions arise by early adulthood—and the difficulty in curing it, the World Health Organization has listed brain illness, led by depression, as the leading cause of disability worldwide. Beyond the suffering brain illness enacts, the financial burden is tremendous, amounting to around $1 trillion annually in the U.S. alone. Nonetheless I remain sanguine—by harnessing scientific data sharing to enhance early intervention in one state, we can start a model to improve mental healthcare and save cost throughout the United States and beyond.
This issue runs deep for me, as it does for many. Flashback to the summer of 1990. I was 18, and had just finished a turbulent college freshman year. Feeling mounting stress at my own perceived inability to define myself as an adult, my family’s history of mental illness caught up with me, and I sustained a psychotic break. Bizarre delusions, anxiety and a dissolving sense of self drove me to the brink of suicide. Fortunately, a friend helped me get to a hospital right away, and I started treatment. This early intervention boosted my recovery prospects. Twenty-seven years later, now that I am living well and stronger than ever, I am pursuing a cause I care about: helping the system care better for young people at risk for serious mental illness.
A Promising Research Foundation
For the last several years, as scientific data sharing has begun to spread, I have grown increasingly optimistic about the potential to improve healthcare for early serious mental illness. In 2014-2015, the pioneering NAPLS 2 study, funded by One Mind Institute and the National Institute of Mental Health, analyzed shared data to show that oncoming psychosis can be detected and treated preventively even before a break occurs. In 2014, an NIMH study called RAISE shared data among 35 programs to establish that treating psychosis early and comprehensively results in better outcomes than treating it later. Based on this evidence, the Substance Abuse and Mental Health Services Administration enacted a block grant to fund programs nationwide to intervene early for psychosis, and around 200 are estimated to be operating in March 2017. These programs, such as those under Oregon’s EASA system, have reduced subsequent hospitalizations by around 50%, enabling significant cost savings. Epitomizing these developments, the NIMH began in 2015 its EPINET initiative, aiming to launch a nationwide network connecting such programs to share clinical and research data to accelerate lifesaving improvements in care.
Even if the apparent impending upheavals in Federal healthcare policy with the American Health Care Act and Medicaid reduction may reduce our system’s mental health capacity, improvements worth making must grow from the grassroots. As Board Director of a pair of leading brain health research nonprofits, One Mind Institute and One Mind, I have assisted private philanthropy to empower scientists to share data to develop better diagnostics and therapies. I have been thrilled to see the advances that the generosity of private individuals has enabled.
Gold from the Golden State
Now, I have taken a leadership role in a project that can help at-risk youth maximize their potential to thrive, by leveraging three non-Federal assets: the private philanthropy I mentioned, and two near-miraculous funding sources in the State of California, the Mental Health Services Act (MHSA), and potentially Proposition 64 of 2016, the Marijuana Legalization Act. This funding may be used to ultimately improve cost-effective care nationwide.
Since its passage in 2004, the MHSA, a 1% tax on the income of all individuals earning over $1 million annually, has generated a growing annual sum amounting for 2017 to about $2 billion for mental health programs in California. Twenty percent (around $350 million) of this total supports programs for prevention and early intervention for mental illness. Beyond this could come some portion of the around $1 billion expected to come annually, starting in 2018, from marijuana sales taxes due to Proposition 64. It makes sense to allocate some of these funds to mental health programs, to mitigate youth substance abuse as self-medication. With such funding in California, early psychosis intervention programs have an especially good chance to shine.
Widening the Net
What if a portion of these funds could be used to connect these programs in a learning healthcare network, modeled on the EPINET, throughout the nation’s most populous state? As California’s Steinberg Institute has championed, why not go farther and expand the collaborative research and care of this network to offer early and preventive treatment for mood, anxiety, and substance disorders as well as psychosis? This “EPI-Plus” network could potentially start accelerating research to improve care within a year, as a proving ground for many of the EPINET’s key ideas. The need for a data sharing technology for this network can potentially be solved, pro bono, by the online platform One Mind has offered, the One Mind Portal.
A Shared Cause
One Mind Institute, One Mind and I have collaborated with the Steinberg Institute and with advocates, scientists, officials, and care program representatives statewide to lay the foundation for this network. I am grateful for the co-leadership that these stakeholders have shown and for their amazing contributions, and we are working to pursue additional public-private funding to connect this network. With the passion of so many brilliant minds applied, I am confident that EPI-Plus will thrive—and will spread better, cost-effective care nationwide.
If you’d like to contribute ideas or resources to jump-starting efficient improvements in care for serious mental illness, please contact me through One Mind Institute’s website. The more advocates working on this, the sooner ubiquitous lifelong mental wellness will become possible.