Mental Health Gets a Boost in Texas

This article was originally published by Harvard Medical School on June 15, 2021. 

A $10 million Lone Star Prize was awarded to Meadows Mental Health Policy Institute for its competition entry, the “Lone Star Depression Challenge.”

In collaboration with the Department of Global Health and Social Medicine in the Blavatnik Institute at Harvard Medical School, the Center for Depression Research and Clinical Care at UT Southwestern Medical Center, and The Path Forward for Mental Health and Substance Use, the Meadows Institute aims to increase the rate of recovery from depression in Texas from less than 10 percent today to more than 50 percent through early detection and treatment in primary care.

The Lone Star Prize, awarded by Lyda Hill Philanthropies and managed by Lever for Change, is a Texas-based competition that was launched in early 2020 to find and fund bold solutions focused on building healthier, stronger communities.

Vikram Patel, the HMS Pershing Square Professor of Global Health, will lead the HMS portion of the collaboration. He will use the EMPOWER initiative to deploy a suite of digital tools to train, supervise, and support community health workers in delivering brief, psychological treatments that have proven effective for treating depression in primary care and community settings around the world.

“We’re at the start of a journey to build the world’s community-based mental health force, which is essential for addressing the vast unmet need for high quality mental health care,” Patel said. “Our initiative uses both established and novel digital tools to leverage decades of clinical and implementation research, giving community health workers the power to implement evidence-based treatments for patients with depression.”

Throughout his career, Patel has led pioneering studies that quantified the health, social, and economic costs of mental illness in low-resource contexts globally. He has developed and tested models of care delivery that leverage available low-cost resources, such as community health workers, to deliver the high quality mental health care described in his book, Where There Is No Psychiatrist. This work is embodied in his long-standing collaboration with the Indian nongovernmental community health organization Sangath.

“The Lone Star Depression Challenge is a fantastic opportunity to build a project at scale in one of the largest states in the U.S.,” Patel said. “Ultimately, we hope our approach will greatly expand the footprint of the existing mental health care system into the community, in particular reaching those who have historically had limited access to mental health care, and show the potential of this innovation to help millions of other people around the nation and around the world.”

Paul Farmer, chair of the HMS Department of Global Health and Social Medicine, offered heartfelt congratulations for Patel and to the other collaborators in the Lone Star Depression Challenge, noting that the prize rightly acknowledges the importance of addressing mental health as a matter of highest importance.

“Every careful study of the afflictions that burden communities, regardless of how they’re bounded, shows that mental illness is at the top of list, while resources to address it remain the lowest of our priorities,” Farmer said. “From India to the United States, Vikram has sought to correct this mismatch, not only by calling it out but by developing effective, safe, inexpensive, and novel community- and family-based interventions to address this imbalance. The world has reason to join us in celebrating this prize.”

In Texas today, an average of eight to ten years passes before depression is diagnosed after symptoms emerge. Because of this, fewer than 1 in 15 of the 1.5 million Texans suffering from depression each year receive sufficient care to recover.

The Meadows Institute says that once fully realized, the Lone Star Depression Challenge will free Texans affected by depression by scaling clinical solutions in health systems, empowering marginalized communities to achieve equitable outcomes, and harnessing purchaser-driven market forces to accelerate adoption of these changes. The Lone Star Prize will enable the collaborators to combine and scale up three innovative programs.

These programs include:

EMPOWER, a suite of digital solutions enabling community-based frontline providers to learn, master, and deliver brief psychological treatments, therefore extending their reach to marginalized communities with limited access to quality care. EMPOWER builds on two decades of research demonstrating that frontline providers can be trained to deliver brief psychological treatments for depression.

Patel will direct the implementation of EMPOWER for the Lone Star Depression Challenge along with project co-lead John Naslund, instructor in global health and social medicine at HMS.

Naslund noted that there are many gaps in mental health coverage across the large, diverse population of Texas, accentuated by deep disparities in coverage between urban and rural communities, racial and ethnic groups, and social and economic strata.

“One of our main goals is to close those gaps, particularly around equity,” Naslund said. Because specialist mental health care is scarce in many communities with high rates of depression, it’s especially important to expand the reach of mental health services to primary care and to strengthen the community health system, he said.

Over the course of the five-year term of the Lone Star Depression Challenge, EMPOWER will train hundreds of community health workers and reach many thousands of Texans in need. Community health workers will learn to recognize depression and to use an evidence-based treatment called behavioral activation, which seeks to break the vicious cycle of social withdrawal and retreat that characterizes depression and replace it with a virtuous cycle of engagement and recovery, Naslund and Patel said. The initiative will also train frontline workers to recognize when patients require specialized care, for example in acute crisis situations, and support a referral system, they added.

The Cloudbreak Initiative, which will scale detection and treatment in primary care centered on two proven approaches: measurement-based care, the routine use of repeated, validated measures to track symptoms and functional outcomes in clinical settings, and the collaborative care model, an integrated approach to the treatment of depression that involves care managers and consultant psychiatrists engaging directly within primary care settings. Together, these approaches have been proven in multiple studies to help at least 40 percent of people treated in primary care achieve full symptom relief and another 25 percent to recover substantially.

The Path Forward, an existing partnership between leading North Texas health purchasers and their national counterparts, harnesses the power of public and private health leaders to reform payment approaches to incentivize health systems to accelerate adoption of effective depression care provided to employees and their dependents.

The Lone Star Depression Challenge deploys proven approaches to overcome the systemic barriers preventing Texans with depression from accessing care sooner and more effectively.

Cloudbreak is redesigning primary care for depression to function just like primary care does today for heart disease and cancer, EMPOWER is making access to evidence-based care more equitable by building a community-based mental health workforce which can link people in the least resourced communities to care sooner, and The Path Forward is harnessing market forces to speed implementation of both approaches.

The Meadows Institute, which will oversee the Lone Star Depression Challenge, was founded in 2014 to help Texas legislators, state officials, members of the judiciary, and local leaders identify equitable systemic solutions to mental health needs and has become Texas’s most trusted source for data-driven mental health policy. The Meadows Institute has begun to make a significant impact in multiple areas, helping Texas leaders shift the focus of new investments toward early intervention, address the mental health crisis in jails and emergency rooms, expand the mental health workforce, and improve access to care for veterans and their families.

“The Lone Star Prize will make possible the first-of-its kind, wide-scale expansion of three proven initiatives to improve the lives of Texans living with depression,” said Andy Keller, president and CEO of Meadows Mental Health Policy Institute. “On behalf of the Meadows Institute and our partners in this project, we are immensely grateful to Lyda Hill, Lyda Hill Philanthropies, and Lever for Change for the opportunity and encouragement to dream big and share these bold solutions across our great state.”

EMPOWER is one of five workstreams in GlobalMentalHealth@Harvard, a University-wide interdisciplinary initiative based at HMS that Patel launched in 2018 to work toward a world where mental health is valued and realized by all through a combination of transformative education, research, innovation, and engagement.

“I am excited to bring evidence-based interventions emerging from global contexts to the U.S. Our rollout in Texas builds on critically important formative work to adapt these interventions for the U.S. and to test the use of digital technologies for training frontline workers,” Patel said, noting that crucial support for the development of EMPOWER’s work on the Lone Star Depression Challenge came from Mala Gaonkar and the Surgo Foundation, Natasha Müller, the National Institute of Mental Health, the Wellcome Trust, and the American Psychological Association.

The full article is available online here.