By Susan Blumenthal, M.D.
June 1, 2015
What if doctors could check a patient's brain vitals just as easily as taking their pulse or blood pressure? Recently, the Food and Drug Administration (FDA) approved several new technologies to help assess brain health and detect emotional and cognitive changes earlier when treatment can be most effective.
This year's Mental Health (May) and Brain Awareness (June) Months arrive at a time of intensified focus on mental illness and neuropsychiatric disorders at home and abroad, underscoring the need for new ways to quickly determine a person's mental and cognitive status in a variety of settings. These weeks of heightened awareness about brain health help promote the importance of early detection of illness and rapid intervention. And technology may be a part of the solution.
During routine medical checkups, physicians measure various physical vital signs such as blood pressure, temperature, pulse and respiratory rate. Any abnormalities in these screening tests would prompt the doctor to conduct or refer the patient for further testing. However, brain vitals -- a simple set of tests easily administered on a smartphone or tablet that measure mood, cognition, reaction time, spatial discrimination and memory -- have yet to be well integrated into routine medical check-ups. Such tests could augment health care professionals' diagnostic powers by allowing them to evaluate and track changes in standardized measurements over time.
Called a "brain thermometer" by the US Army's Combat Care Research Program, a new FDA-cleared app is proving helpful in military settings to help identify traumatic brain disorders (TBI), concussions, post-traumatic stress disorder (PTSD), and depression in members of the Armed Services. The tech expert behind this new software suggests that this tool could also be used in general health care settings as well. In the near future, it may be possible for doctors to take brain vitals on all of their patients, helping them catch worrying symptoms of emotional distress and neurocognitive changes that signal the presence of a TBI, concussion, or mental illness. Improving early detection of these conditions can help prevent needless suffering -- an important step in reducing the impact of mental illness and cognitive impairment in America and worldwide. The software might also be used during rehabilitation to evaluate progress or decline after a neurological event such as a concussion or stroke. This innovative app approach provides a portable, user-friendly method to evaluate multiple components of vital information related to brain health.
Globally, mental illness takes an enormous toll on individuals, families, and society as a whole,accounting for approximately 7.4 percent of the global burden of disease from all causes in 2010. In the span of two decades, from 1990 to 2010, the global burden of mental and substance abuse disorders increased by 37.6 percent, almost entirely attributable to population growth and aging.  Not only are these disorders increasingly prevalent -- they also do not discriminate, affecting people of all ages, races, socioeconomic groups and both sexes. In 2012, one in five American adults -- 43.7 million people -- experienced a mental disorder.  But only 41 percent received mental health services in that year.  Additionally, one in five children, ages 15 to 18, either currently or have at some point experienced a "seriously debilitating"mental disorder.  And as more members of the baby boom generation reach the age of retirement, mental illness is expected to take an increasing toll on the already-stressed U.S. health care system.
A glance at the numbers demonstrates the enormous human and economic costs of mental illness -- in dollars and in lives.
The direct and indirect costs of mental illnesses to the U.S. economy is an estimated half a trillion dollars a year.  Medical expenditures for mental illnesses in the U.S. were $57.5 billion in 2006. 
Patients who had a mental illness at any point in their life are twice as likely to have experienced a stroke or heart disease than the general population.  People affected by depression are three times more likely to develop Parkinson's disease. 
Adults in the U.S. living with serious mental illness die on average 25 years earlier than the general population, largely due to treatable medical conditions.
Mood disorders, such as major depression, dysthymic disorder and bipolar disorder, are the third most common cause of hospitalization for people aged 18 to 44. 
In 2010, 38,364 people in the United States died by suicide -- an average of 105 each day. 
Suicide was the tenth leading cause of death in the U.S. and the second leading cause of death for youth aged 15 to 24 in 2013. More than 90 percent of children who die by suicide have a mental illness.
An estimated 18 to 22 veterans die by suicide each day. 
Given the high prevalence of mental illnesses, their painful symptoms and costs to society, why don't more Americans seek mental health services? There are many reasons, but two explanations include the lack of health care coverage for mental illness and a lack of awareness of the symptoms and impact of these disorders. A new report released last month by the National Alliance on Mental Illness (NAMI) helps explain the health coverage factor. The report revealed that mental health parity (equal insurance coverage for mental illness as for physical health problems) was far from a reality despite passage of the Mental Health Parity and Addiction Equity Actin 2008 and the Patient Protection and Affordable Care Act of 2010. In other words, many people still cannot afford mental health services because their insurance does not provide comprehensive coverage for treatment of these disorders.
The second reason is that people often don't recognize symptoms of a mental disorder in its early stages. In fact, according to the National Institute of Mental Health (NIMH), the median delay between the appearance of first symptoms and seeking treatment for mental illness is nearly a decade.  Furthermore, stigma still surrounds these disorders so that many view them as personal weaknesses or character flaws, rather than as real, disabling illnesses just like heart disease or diabetes. This postponement of seeking treatment can result in more severe, more difficult to treat conditions as well as the development of co-occurring addictive disorders.
Mental illnesses are very widespread and can be health damaging, but they are also observable and treatable. A cornerstone to achieving better mental health outcomes lies in screening and early detection. A study revealed that when screening tests were administered during a primary care visit, doctors were over three times more likely to recognize the symptoms of mental illness and to follow up with their patients.  Treatment for mental illnesses detected through such screening tests has also been shown to effectively reduce patient's symptoms. Between 70 and 90 percent of individuals experience decreased symptoms and improved quality of life with a combination of pharmacological and psychosocial therapies.  These findings underscore how important it is to better integrate mental health into primary care.
Efforts to promote early detection of mental illness are not new. Various screening tests already exist for identifying signs of mood disorders and cognitive changes including memory impairment. However, these tests are not regularly administered at routine medical check-ups. If they are included, depending on the way the physician asks the questions, or due to any miscommunication between the doctor and patient, the results may vary. What technological tools offer is a standardized measurement system that may be less prone to subjectivity and bias. Some patients may answer questions more accurately if they are responding to an electronic test compared to answering questions by their primary care doctor. Additionally, patients may perform simple cognitive tasks more easily without the presence of a physician waiting for their response. Additionally, some health care providers and patients are not comfortable talking about mental health issues. Moreover, having an app collect data can save time for a primary care doctor and allow them to follow up with questions as well as map trends in their patients' mood and cognition over time. These types of technologies cannot and should not supplant the doctor-patient relationship; rather, these e-screening tests would add another useful tool to the physician's diagnostic toolbox. They can also collect information that is helpful in determining the need for referral to a mental health professional or neurologist. And in the future, these apps might be applied in settings beyond the doctor's office - on the battlefield, in schools and in athletic arenas -- to assess psychological and cognitive functioning after an injury or other traumatic event.
In 2009, a study found that the simple act of a surgical team asking a set of nineteen questions before and after an operation such as, "Do we have the right patient?" and "What operation are we performing?" reduced the rate of deaths and postoperative complications by about 30 percent.  Similarly, the simple act of measuring "brain vitals" during routine medical check-ups as part of a verbal mental status exam and with e-screening tools could increase the detection of mental illness, TBIs, PTSD, and cognitive impairment in clinical practice. New mobile technologies may also help reduce the high costs and needless suffering associated with these disorders by detecting these conditions earlier when treatment can be most effective. The observance of Mental Health and Brain Awareness Months provides opportune moments to highlight such innovations for improving mental health care in the 21stcentury.