Mental health needs disruption on a massive scale!

It's estimated that 20% of Americans have a mental disorder of some kind; BTW that’s 44 million people. Around 70% of youth in juvenile justice systems have at least one mental disorder and at least 20% live with a serious mental illness. Another 20% of State prisoners has mental disorder. Nearly 1 in 2 people – that’s all of us now - will suffer from a mental disorder in their life.

You get the gist. Mental health is a disaster which has already happened and affects most of the US population in one way another.

Check out the recent announcement of a chatbot – an AI, right? – that provides mental health care. The chatbot uses cognitive behavioral therapy – CBT to the cognoscenti – to treat mental disorders. So that sounds promising, right?

For those of you in the know, CBT is regarded as the gold standard amongst psychotherapists for addressing many mental disorders. It has received many plaudits from the NIH. But maybe that’s a poisoned chalice.

The latest reviews – from psychotherapists no less – provide evidence to sharply question that CBT has any real benefits when held up to the light of evidence-based medicine (“ Is Cognitive Behavioral Therapy as Effective as Clinicians Believe?”). So, this bright hope isn’t one at all, much as it is needed.

Part of the problem is that what we call mental illness is a many-splendored thing. It spans diverse topics such as  anxiety disorders: mood disorders: psychotic disorders: eating disorders: impulse control and addiction disorders: personality disorders: obsessive-compulsive disorder (OCD): post-traumatic stress disorder (PTSD): and so on. Probably these have widely different causes and thus solutions.

Right now, the state-of-the-art, such as it is, is to use drugs. It’s a blunderbuss approach where just a few drugs tackle just about everything. So, you don’t get a cure or anything remotely approaching one. You get – if you’re lucky – a temporary remission of symptoms, usually accompanied by lots of serious side-effects.

We don’t know what causes all these metal disorders. It could be a biological agent such as a bacterium, virus, prion, or a chemical imbalance, our gut microbiome, brain disorder, a neuronal defect, or so on. We just don’t know.

And note that I’m not even talking about Alzheimer’s and dementia generally here. They are in a class all by themselves. We have no cure for them either and don’t know how they are caused.

There’s numerous treatment institutions out there. They range from battleships like hospitals, to fishing boats like local mental health centers. In-between there’s a range of lesser and greater institutions staffed by therapists, doctors, mental health counsellors, drug addiction specialists and many others I don’t even know about. By the way that also includes every ER center in the US which also are involved in treatment of mentally afflicted people, who even mental health treatment centers often won’t treat.

And there’s also a vast number of prisons that double as unofficial mental health centers. So, there are a huge number of law enforcement people – the cops on the front lines, corrections officers and so on, who also temp quasi-officially, as mental health para-professionals. They also have their own ways of treating people with mental health disorders, even if its only to take them to a treatment center or hospital. Often that treatment isn’t good, being off-the-cuff, since that isn’t even their job.

There are some optimists who think that engineering solutions are emerging like deep-brain stimulation for Parkinson’s disease. But we don’t even know how to cure Parkinson’s let alone Alzheimer’s. Technology and AI, which are the great white hope for so many problems, offer no hope at this stage.

Why is that? We don’t even have a philosophical framework to tackle the issue. How so? Right now, our general concept is that mental disease is generally one that involves the brain only. What if it doesn’t? What if it’s really caused by a gut microbiome that’s out of whack? A malfunctioning immune system? The vagus nerve playing up? One, several, numerous different biological agents? Environmental pollutants? Genes? Epigenetic factors?

And even if it is the brain only that’s the cause, we still don’t know what’s going on. Coz we don’t even know how the brain works, except at the most gross levels. So, no hope there either.

Drugs, opioids, addiction and so on just add yet more fuel to the fire. Maybe vaping will too (see my recent post “Is vaping actually a medical breakthrough?”).

Our healthcare system in the US basically ignores mental health. Sure, some lucky people have coverage; the vast majority don’t. Bad luck if you or your family need treatment. And even if you get it don’t hold your breath that it will make any difference.

Governments have shelved the problem. Even the medical associations have done so. Mental health isn’t sexy like heart disease, cancer, or even Alzheimer’s (not that it has fared any better).

We need a major disrupter and major disruption in this area. If it doesn’t come from all-powerful tech, where then?