The Affordable Care Act incentivizes prevention, which is the process of identifying and remedying a disease before it occurs. With well-known diseases such as coronary artery disease, which costs the United States about $43 billion per year, there are well-established personalized, predictive, and preventive plans of action. We can identify risk factors for such diseases and have validated plans of action to prevent or slow disease onset.
For another extremely costly disease like schizophrenia, which costs $33 billion per year, preventive measures and diagnostic tests have lagged behind disorders of physical health; mental diseases are more complicated to predict and prevent. 7.9 million Americans suffer from schizophrenia and bipolar disorder. Therefore, the recent development of programs and research to detect mental illness early is a much-needed work in progress.
The Affordable Care Act has facilitated the development of such programs, for example the National Demonstration of Early Detection, Intervention and Prevention of Psychosis in Adolescents and Young Adults (EDIPPP). EDIPPP uses community interaction “including family members, teachers, social workers, doctors and nurses” to identify teens and young adults at risk A similar program, RAISE, is a research project funded by the National Institute of Mental Health that seeks to fundamentally change the trajectory and prognosis of schizophrenia through coordinated and aggressive treatment in the earliest stages of illness. The success of programs like EDIPPP and RAISE is in their prevention of psychosis early, before it becomes debilitating to the individual and a burden on the health system. In fact, the most economically effective treatments are related to early childhood development programs. A combination of genetics and environmental factors contribute to the development of psychiatric disorders in an individual. Programs such as EDIPPP work to detect the potential of a disorder and treat the environmental aspect of the issue using a patient centered approach.
Moreover, genetic testing is another innovation used to detect indicators of mental illness, which aids in early diagnosis and prevention. Unfortunately, no genetic test can predict definitively who will and who will not become mentally ill. However, certain tests can help in predicting the possibility and risk. Paired with a program such as EDIPPP, genetic testing and risk prediction models could prove invaluable in the future of mental illness prevention. Currently, genetic testing in the mental health field is most useful in predicting the likelihood of developing psychosis in a patient with a family history of mental illness. Careful analysis of the last three generations of family psychiatric history is still the most useful tool in predicting risk or illness onset. Paired with a program such as EDIPPP, family history and genetic testing for risk prediction could prove invaluable in the future of mental illness prevention.
There is a better way to mitigate the costly burden of mental illness in the United States. Prevention allows individuals who would not have been in control of their lives and futures to take steps to live normal, healthy, lives. Environmental, patient centered, social programs such as RAISE and EDIPPP serve as the “ying” in treating and preventing mental illness while the “yang”, genetic research and validation of models for risk prediction, compliments these programs and gives those fighting mental illness another weapon in their arsenal. There is a clear path forward ahead for mental illness recognition, management and prevention as the battle against mental illness is coming into the spotlight.
Rosie Wood is an intern for the Duke Center for Research on Personalized Health Care and a senior attending the University of North Carolina at Chapel Hill.