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Vital signs for mental health

Kaiser Permanente psychiatrist advocates for a data-driven approach to tracking patient symptoms and improving treatment

It might be easy to view mental health treatment as more art than science, given the focus on slippery emotional states of mind. But psychiatrist Kathryn Erickson-Ridout, MD, MPH, is among those who believe the field is plenty scientific, and that patient care should reflect that by using data-oriented techniques to track symptoms and inform treatment.

The approach is called measurement-based care (MBC). It is championed by the American Psychiatric Association (APA), whose Council on Quality Care published implementation guidance about it in 2023. But the concept has not been adopted widely, particularly among solo practice and small-group clinicians who may lack the necessary time and technology.

Kathryn Erickson-Ridout, MD, PhD

By contrast, Kaiser Permanente Northern California mental health practitioners use symptom metrics routinely, particularly to track depression and anxiety symptoms of those in mental health care. This is usually done by having patients fill out validated, diagnosis-specific screening and outcomes questionnaires ahead of appointments.

Erickson-Ridout led the development of the APA implementation guidance in 2023 as well as a new paper in Psychiatric Services that addresses ways to make a scientific approach to mental health care more broadly adopted. She answered our questions about measurement-based care.

Why did you think it was important to advocate for this approach?

Measurement-based care is the process of repeatedly assessing patient status by asking them about their symptoms, quality of life, functionality, and satisfaction with care. There is now a solid body of evidence that shows that systematically collecting this information from patients, and using those metrics to guide treatment, results in improved outcomes in many mental health diagnoses.

I’m the co-chair for the Measurement-Based Care Workgroup for the APA and we wrote this paper in Psychiatric Services to spread the word among clinicians about this important technique. It is the most simple and scalable intervention we can do, supported by consistent evidence across multiple randomized controlled trials. There is strong evidence that it improves patient care, plus the metrics can help mental health clinicians participate in the latest quality-based payment models. But the adoption rate across the country is fairly low, under 25% of providers.

What does the evidence say?

Patients receiving measurement-based care have up to 75% greater remission rates compared with patients receiving psychiatric treatment without routine symptom measurement. Symptom rating scales — the screening and outcome questionnaires that patients fill out — have also been validated by research. The APA’s Practice Guidelines for the Psychiatric Evaluation of Adults recommends the use of quantitative measures as part of evaluating patients and monitoring their treatment.

It gives us a way to actually see and quantify the patient’s status so the psychiatrist or therapist can take action that is responsive to the patient’s needs.

—Kathryn Erickson-Ridout, MD, PhD

How do patients respond to this approach?

Most of the screening tools are filled out right before the visit — the patient receives a secure message that allows them to fill it out at home online before a virtual or in-person visit. Our patients are familiar with a measurement-based approach to mental health care due to ongoing engagement from our clinicians around the impact of participation in MBC on their overall treatment journey.

We don’t have tests like blood pressure or hemoglobin in psychiatry. But we do have what the patient’s telling us, so most of these measurements relate to the symptoms of whatever disorder they have, like depression or anxiety. So it’s quite aligned with personalized care to understand how medications or therapy are working. It gives us a way to actually see and quantify the patient’s status so the psychiatrist or therapist can take action that is responsive to the patient’s needs.

How does Kaiser Permanente Northern California use measurement-based care?

I’ve seen the power of measurement-based care in my own practice because our operational team has done a really great job of implementing it and making those tools available to all therapists and psychiatrists. I screen every mental health patient at every visit for things like depression, anxiety, medication use, substance use, overall mood, and satisfaction with care. In primary care, they’re screening for depression once a year for people with a history of depression, and we are moving toward universal screening. We also screen for PTSD at every intake appointment in mental health.

What does your workgroup recommend to expand use of this technique?

Because we have good evidence supporting measurement-based care, and it is supported by APA practice guidelines, much of the work is spreading the word to clinicians about the value of this approach. Some clinicians in small-scale practice may have concerns about the time it would take to screen patients and record the information in the medical record, but there’s been a major improvement in incorporating these methods in electronic patient records. And mental health providers have been giving patients paper-and-pencil screenings for decades, and informally using that information to guide patient care. By adopting a more formal process for collecting and managing patient outcomes, we think providers will actually save time and improve both quality of care and patient satisfaction.

 

 

 

 

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