Depression is the top cause of disability globally, yet significant barriers block individuals from accessing the full spectrum of evidence-based mental health treatments.
There are 8.9 million adults in the U.S. who have both major depressive disorder and treatment-resistant depression (TRD), meaning they have tried at least two traditional treatments like Selective Serotonin Reuptake Inhibitors (known as SSRIs) and talk therapy and experienced little lasting change. This has left them scrambling for innovative treatments, including ketamine.
Many forward-thinking clinicians are already using ketamine in their practice through IV ketamine or ketamine-assisted psychotherapy due to its effectiveness. In one study, severe depression rates reduced from 75% to 21% in patients receiving ketamine for TRD. Ketamine is currently the only FDA-approved compound out of the loosely associated umbrella of “psychedelics” approved for off-label use. There has been growing awareness surrounding innovative treatments’ positive impact.
Despite that, an Osmind-led survey highlighted the challenges faced by innovative mental healthcare clinicians. The survey showed that of 75 clinics offering ketamine treatments, they are on average at 60% capacity for patients seeking services, hindered by lack of insurance coverage of ketamine and a number of administrative hurdles.
The same barriers impede other interventional modalities such as Spravato and transcranial magnetic stimulation (TMS), in addition to ketamine—and serve as an example of what’s to come for other innovative treatments. In our survey, 77% of respondents say they plan to offer psychedelic therapies, such as MDMA and psilocybin-assisted therapy. However, clinicians are concerned about legal roadblocks and data on long-term efficacy–which will have a wide-ranging impact on innovation and access in the space.
We can do better.
For the first time in 50 years, we’re at a powerful tipping point in the development of new psychiatric interventions to serve this group of individuals, similar to the precision oncology transformation of the past 20 years. Based on the results of the survey, combined with my experience working with hundreds of clinicians and researchers, this is what I believe: We must support groundbreaking work by equipping innovators with modern technology—this is the key to unlocking a better future for millions.
Below are the top three things innovative clinicians need to best deliver proven care to the patients that need it most, at scale.
More time and energy to focus on patient care
A 2022 study found that full-time physicians spend 3.5 to 6 hours per day inside electronic health records (EHRs). Most of this time is spent on clerical and administrative tasks, such as repetitive logins and inbox management, creating a significant time burden while also consuming valuable time that could be spent on patient care.
This problem has snowballed since the HITECH Act of 2009, which the government enacted to enforce the use of technology in the clinical setting. Much of the software developed as a result of these laws were aligned to government regulations and not intentionally designed to make clinicians’ jobs easier.
These administrative burdens become even more exacerbated when clinicians offer innovative treatments that may not yet be the standard of care.
For example, esketamine nasal spray (branded as Spravato®) requires that clinicians fill out additional patient enrollment and monitoring forms as part of the FDA’s Risk Evaluation Mitigation Strategy—amounting to hours of additional documentation time every week.
The solution to administrative work is better EHR solutions that are designed to remove barriers, not create them. Software that considers relevant time-saving measures, such as automating specific workflows for innovative treatments—which reduces time spent on administration and superbill generation—allows clinicians to reclaim their focus on patients.
Support measurement-based care
Measurement-based care (MBC) involves the systematic evaluation of patient progress throughout a treatment, including the administration of symptom rating scales. MBC operates from a simple concept: if you can’t measure it, you can’t treat it.
Clinician adherence to MBC improves both the patient experience and advances future access to treatment. Studies show that patients feel more engaged in their own therapeutic process with MBC since it gives them tools to monitor their own progress, contributing to a sense of control over their treatment journey. Importantly, MBC also improves clinical outcomes. Yet, only 18% of psychiatrists and 11% of therapists implement MBC, citing obstacles such as lack of time and adequate training, despite proven benefits.
Software can materially improve the way MBC is conducted within innovative clinics by streamlining data collection and outcome measures. By removing the workflow and time barriers blocking clinicians from contributing to MBC through better technology systems and processes, we can contribute to improved clinical outcomes and experiences for patients seeking intensive mental healthcare.
Better patient access to more innovative forms of mental health treatment, through leveraging real-world evidence
Our survey found 83% of patients can’t afford ketamine treatments. Out-of-pocket fees can reach as high as $1,200 per session for Intravenous (IV) ketamine. Clinical guidance recommends that patients typically pursue on average six sessions to see clinically significant results.
Even FDA-approved treatments for depression like Spravato and TMS haven't reached their full potential in reaching the patients who might benefit due to lack of comprehensive insurance coverage. This is often because insurance companies require significant amounts of data, even outside of the clinical trial setting, to make coverage decisions.
Collecting data on outcomes and treatment efficacy in everyday settings, through MBC, is critical to filling the gap. By de-identifying and pooling treatment data at scale, researchers can produce evidence that influence politicians to lobby for increased access and payers to increase insurance coverage for proven therapies. This coverage would unlock access to life-saving care for millions.
Real-world research will establish the safety and efficacy of new treatments and advance guidelines for patient care, support the case for expanded insurance coverage and unlock new therapeutic pathways. One example is ORKA-1, the largest real-world ketamine outcomes study for treating patients with TRD, which Osmind conducted with leading physician-scientists at Stanford University School of Medicine. While randomized controlled trials for ketamine exist in academia, more are needed to ease insurance companies’ hesitancy in approving insurance reimbursement.
Software can serve as the infrastructure for bottom-up real-world evidence data collection at scale. By simultaneously giving clinicians time back while facilitating research, they’ll establish the safety and efficacy of new treatments and advance guidelines for patient care, creating a virtuous cycle that unlocks new therapeutic pathways.
America’s most innovative clinicians are facing significant challenges delivering mental health treatments to patients. We can streamline administrative work through more clinician-focused technology, support evidence-based practices such as measurement-based care, and support data collection to advance research. This is our opportunity to improve patient care while advancing access to a broader spectrum of proven interventions.
The millions of people suffering from moderate to severe mental health conditions deserve better care options. Meaningfully supporting front-line researchers and clinicians in advancing new life-saving mental health treatments is one of the best ways to help them.
Lucia Huang is co-founder and CEO of Osmind. Prior to Osmind, she led business and operations at Verge Genomics, a next-generation biotechnology company leveraging artificial intelligence for central nervous system diseases such as ALS and Parkinson’s. Before Verge, Lucia was a growth investor at Warburg Pincus. She started her career as an investment banker advising the world’s largest pharmaceutical companies while at Evercore.