Now and Then: Universal Mental Health Screening for the 21st Century
By Dr. Gerald Hurowitz, MD
WhatsMyM3 Chief Medical Officer
If current trends continue primary care practices across the US will soon be screening for mental illness on a universal basis. The rationale for such screening has existed for some time: it is well-established that mental illness worsens the course and interferes with the effective treatment of physical illnesses of virtually every type, acute and chronic. Treating these mental disorders effectively will save money and improve healthcare for all. Yet, for years screening strategies have languished in the US healthcare system. Now is the time of reckoning: for every day without such screening, avoidable costs are added to our growing healthcare bill.
Why has this not happened already? The answer resides in the nuances, the variability and interchangeability, of mood and anxiety disorders. Numerous studies have demonstrated that depression, the prototypical mental disorder of our age, is easy enough to screen for. But, the single-minded determination to focus on depression screening misses the big picture, and thereby creates other problems. Here’s why. Overlapping with depression are the even more common anxiety disorders, and overlapping with both of these conditions are the bipolar disorders. While bipolar disorder is less common than ordinary depression and anxiety, its mistreatment – naturally more likely when it is misdiagnosed – creates tremendous pain, suffering, and unnecessary healthcare costs. These big three – depression, anxiety and bipolar disorder – will often express symptoms that overlap and that change, both with and without treatment, as the conditions progress. It is not unusual to find these diagnoses co-existing in the same individual. A once-a-year screen for depression fails, in many cases, to capture and encompass mood and anxiety disorders as they present in the real world.
Clinicians in their office practices do not yearn for a screen that merely finds cases of depression. When offered such screens, the practices that do use them generally do so in a perfunctory way. Rather, what doctors need is a tool that helps to distinguish between cases of ordinary depression, bipolar disorder, and anxiety. And at yet another level of complexity, clinicians also want to be able to grasp how alcohol and substance use contribute to their patients’ mood symptoms. Looked at piecemeal, the various behavioral disorders doctors confront cannot be properly framed and managed. It is not depression OR anxiety OR alcohol abuse that is the problem in most cases. It is, rather, a hodgepodge of emotional turmoil, irritability, passivity, obstinacy, and chaos that primary care must deal with in many such patients. A simple, static, annual screen for depression just does not cut it.
Holistic, multi-dimensional, and adapted to longitudinal monitoring, a mental health screen for the 21st century must capture the behavioral disorders as they evolve in all of their myriad presentations. The M3 was designed to address exactly these demands. A computer interfacing, self-rated 27-item questionnaire that can be completed in less than 3 minutes, the M3 finds cases of depression, anxiety, PTSD and bipolar disorders. At the same time, it surveys patients’ alcohol and substance misuse patterns, as well as functional impairment, all in the context of their ongoing mood and anxiety symptoms. Most importantly, it enables progress to be monitored and provides vital, graphically intuitive feedback to the treatment team. With such valuable feedback, the M3 has the potential to improve the quality of care through repeated use.
The M3 checklist is accessible through numerous channels: on the web at whatsmym3.com, at the physician’s office at M3Clinician.com, and on any smart phone via the WhatsmyM3 app. This accessibility means that individuals may screen themselves, but also track and follow their response to treatment, whether psychotherapy or medication, over time.
Primary care has a formidable task as it takes over more and more of the treatment of these disorders. The training of our healthcare providers must be fostered and the success or failure of such training must be measurable. Again, an annual depression-only screen will never provide the sort of measurable, real time feedback that would help in this important endeavor. Screening, monitoring and clinical support via the M3Clinician’s cloud based software can provide what is needed to measure, support, and improve the management skills of the primary care office. The M3 is a mental health instrument for the 21st century.