Creating Pathways for Measurement-Based Care in Behavioral Health

We are excited to launch the Ethos Newsletter! Each week, we will interview top experts in addiction care and behavioral health to help equip everyone to take action against addiction.

For this week's newsletter we interviewed Ethos Medical Advisor, Arpan Parikh, MD, MBA, FAPA . Arpan is a double-board-certified physician?specializing in general psychiatry and addiction medicine. He has spent his career caring for patients with substance use disorders across a variety of settings, including inpatient, outpatient, emergency rooms, and dedicated SUD treatment programs. He is the Chief Medical Officer of SOL Mental Health , a next-generation comprehensive outpatient mental health platform that delivers care across 6 states. He also sees patients in his private practice and advises several digital mental health start-ups and healthcare-focused investors.

We are excited that Arpan is joining the Ethos team as a Medical Advisor. He will bring his knowledge and experience in the space as we work to expand access to life-saving alcohol use disorder care.

What is "measurement-based care," and why is it important in behavioral health, specifically in addiction care??

Measurement-based (or measurement-informed) care is in its infancy when it comes to behavioral health (and particularly SUD) care. I think of measurement-based care (MBC) as being anchored on three key criteria: regular use of validated metrics to inform treatment. MBC only works if the data points are collected regularly (more data points --> more clinically useful signal), if the questions we ask / scales we use are validated (need to understand the reliability and consistency over time), and maybe most importantly, the data is used to inform the treatment process. Many people express hesitation about MBC, some of which stems from anxiety around how the data will be used. Ultimately, more data and information are crucial to providing the best care to patients. MBC should never replace or usurp clinical judgment; however, it can be disheartening to see some cast MBC out as never playing a role in behavioral health. We've been slow to adopt new technology and treatments and owe it to ourselves and our patients to bring MBC into the fold.

What brought you to do work in this space?

Although we've made strides over the last decade, Americans experiencing mental health conditions still face tremendous bias and stigma when seeking care. What I was not prepared for as I entered residency was that patients suffering from substance use disorders are subject to even more stigma and bias in accessing care. I could not believe that even mental health clinicians themselves would often profile patients with SUD in a way that created barriers to care. So, I found caring for this population extremely rewarding and mission-driven. This, combined with two amazing mentors ( Timothy Brennan and Prameet Singh ) at NYC's Mount Sinai and what I saw as one of the next frontiers with regard to white space for new treatments and technologies to emerge, led me to choose the intersection of general psychiatry and addiction medicine as my area of clinical focus and subspecialty.

What is the biggest obstacle we are facing right now in addiction care?

I see a lack of access as the single largest obstacle we face today in caring for patients suffering from SUD. There are nowhere near enough specialists to care for the population, and thus far, we haven't done a great job of arming generalists and front-line specialties (primary care, family medicine, pediatrics, and emergency medicine) with the tools and skills to treat SUD comfortably.

Where do you want to see new solutions emerging in addiction care??

There are two areas that excite me:

1. Measurement-informed care: as I discussed, measurement-informed care is going to play a crucial role in treating SUD as the behavioral health field as a whole moves towards an outcomes- and quality-oriented framework. We need more tools and platforms to enable this.

2. Next-generation therapeutics: there are many exciting compounds currently in Phase I, II, and III FDA trials for the treatment of SUD (including derivatives of psilocybin, ibogaine, mescaline, and ketamine). While the recent FDA advisory committee recommendations on MDMA-assisted psychotherapy in the treatment of PTSD have tempered some expectations around next-gen therapeutics, I am still overall excited by the opportunity next-gen molecules hold in treating SUD.

A special thank you to Arpan for sharing his insights!

Be sure to follow + subscribe to Ethos newsletter for weekly drops, where we interview top experts in the addiction care and behavioral health space. Know someone who would be a good voice? Message us!

Ethos is a tech-enabled platform that helps individuals and their care teams monitor and manage alcohol misuse across its spectrum of risk. We aim to meet people there they are, regardless of their stage in recovery.