Routine screenings take a quick snapshot of your overall health: your weight, your blood pressure, the state of your guts. The not-so-magic word here is “routine”: It’s a simple but imperative baseline by which your doctor documents your well-being.
Expanding that routine to include mental health, the state of our brains, could improve lives. It could save lives.
But changing long-established routine is no easy matter. A $10 million jump-start would surely help.
Dallas billionaire philanthropist Lyda Hill provided just that Tuesday when her foundation awarded the Meadows Mental Health Policy Institute its Lone Star Prize for a proposal that aspires to transform how the entire medical community deals with depression.
Today’s health care system fails to take diagnosing mental illness — which 10% to 20% of us suffer from — with the same seriousness as catching physical diseases. Too often, depression isn’t detected and treated early or effectively.
You don’t have to be an expert to know that. If your family hasn’t yet been touched by mental illness, it won’t take long to find one that has.
They may still be grieving a death related to mental illness, searching for one of the scarce hospital beds for their children or bewildered after calling 911 for help only to have a loved one wind up in jail, not the ER.
The Meadows Institute proposal, fueled by the Lyda Hill Philanthropies award, aims to change those outcomes across Texas with a deceptively simple but rarely practiced response: Apply the same strategies that transformed care for heart disease and cancer over the last two decades to save thousands of lives and improve health outcomes for hundreds of thousands.
Even before the pandemic, barely 1 in 15 of the more than 1.5 million Texans suffering from depression each year received decent care, according to the Meadows Institute. A tragically large number of those individuals are among the nearly 4,000 people who die annually by suicide across Texas.
In the latest evidence of COVID-19′s puncturing of an already unsteady state of mental health, the Centers for Disease Control and Prevention reported Friday that teenage suicide attempts rose dramatically in the first part of 2021 from the same period before the pandemic.
Andy Keller, president and CEO of the Meadows Mental Health Policy Institute, compared the situation to what we Texans are all too familiar with after a devastating hurricane or tornado.
“We see people make initial attempts to cope, but then sometimes those break down,” Keller told me. “We’re seeing a lot of folks struggling as things open back up to try to find their place in this new world. Those pre-existing epidemics of mental illness, suicide and addiction — unfortunately, they are probably worse than they’ve ever been.”
The Meadows Institute created its Lone Star Prize-winning response in partnership with the Center for Depression Research and Clinical Care at UT Southwestern Medical Center and Harvard Medical School’s Department of Global Health and Social Medicine.
Dr. Madhukar Trivedi, head of the UT Southwestern center, was still giddy when we talked about the award — and with good reason. “This kind of investment and prominent play happens for cancer or heart disease. For it to happen to depression, it almost feels like a new day,” he said.
Philanthropist Hill said the events of the past year have made clear to everyone that we must find solutions for our growing mental health crisis.
She was happy to see the Lone Star Prize go to the Meadows Mental Health Policy Institute because “they pioneer a transformative strategy to detect and treat depression that has the potential to scale well beyond our state and serve as a guide for the rest of the country.”
The Meadows Institute will recruit health systems willing to enlist their primary care doctors in getting the tools and extra help needed to screen, detect and track depression symptoms. Methodist Dallas Medical Center has already signed on.
Dr. Keller hopes to grow the effort to 15 to 20 big health operations reaching 10 million Texans annually to offer the new services.
“People who go to the doctor will be identified early … and receive care right there from a behavioral health care manager or a psychiatrist in that primary care office,” Dr. Keller said.
The effort also will help businesses, government and other health care purchasers expand access and offer better mental health and addiction aid to employees.
Another goal is to equip in-the-field health workers with tools to screen residents at places such as churches or rec centers. That’s key to reaching communities of color and other Texans lacking equitable access to care.
The work will focus on six major markets, including North Texas, Central Texas, West Texas and the Rio Grande Valley.
Lyda Hill Philanthropies announced the Lone Star Prize competition in March 2020 as a way to uncover the very best idea to improve health care, protect the environment or boost the workforce of Texans. Lever for Change, an affiliate of the John D. and Catherine T. MacArthur Foundation, managed the process.
The Meadows-led proposal, dubbed the Lone Star Depression Challenge, was one of more than 170 entries analyzed by 200 subject-matter experts and civic leaders in four categories: Are they transformative, scalable, feasible and evidence-based?
Dr. Trivedi has worked relentlessly for more than a decade to get primary care doctors to put depression, which is among the most common mental health concerns, on equal footing with physical maladies.
“This is about evidence-based approaches that allow someone to get the same kind of quality care for depression that they should get for hypertension and diabetes,” he told me.
That makes so much sense. Yet depression is still considered a mystery — and so foreign to family practice medicine — that it’s no wonder help seldom arrives until a full-fledged mental health crisis occurs.
The rigorous national vetting process involved in the Lone Star Prize brings validity to this standard of care. “This is not just me continuing to say how important and necessary this is,” Dr. Trivedi said, “but external people saying this is important.”
Dr. Keller said his team’s research has revealed big potential wins under the new approach’s one-two punch of authentically integrated care and evidence-based screening and monitoring.
At the least, he said, those factors will achieve remission of symptoms in 40% of cases. An additional 25% of depression patients will make substantial progress.
“Chances are good they won’t die of suicide and they probably can go back to work or school,” he said. “Two-thirds of people, in other words, will be good enough to go about their lives again.”
In contrast, that projected 65% total is at best 6% right now “because we just miss the depression piece,” Dr. Keller said. “We’re just not looking and we’re not doing a good job.”
Like Dr. Trivedi, Dr. Keller pointed to the foolishness of “othering” mental illness.
“We’ve made great advances in heart disease and cancer, but not because we know how to resuscitate people better. It’s because we get to people before their heart stops.”
The same strategy must apply for depression: Look for risk factors. Look for early signs. Then help. Sometimes that’s as simple as lifestyle changes or counseling.
Dr. Keller has worked in mental health since 1988 and been a psychologist for 25 years. But he said it wasn’t until 2013 — during a conversation with Linda Evans, then president of the Meadows Foundation — that he realized he wasn’t seeing the mental health forest for the trees.
“I was busy in clinics helping the people in front of me,” he recalled. Evans challenged him with the question “Why don’t we look at everyone’s mental health, just as we do other markers?”
The Meadows Mental Health Policy Institute launched a year later to identify and try to implement improved mental health ideas and practices
The Lone Star Depression Challenge will be a heavy lift. But with the Lyda Hill Philanthropies’ Lone Star Prize as rocket fuel, I’m betting the teams pull it off.
Their success matters a lot to your family, to mine and to tens of thousands of others. As Dr. Keller told me: “Without this acceleration, we are looking at maybe a 30-year wait. That would be losing a million people across the country between now and then who don’t need to die.”
