written by Dr. Tobias Marton, Chief Medical Officer of Mindful Health Solutions
The Challenge of Clinical Inertia in Psychiatry
“Clinical inertia is defined as the failure to initiate or intensify therapy when treatment goals are not met and is a well-recognized barrier to improving patient care and clinical outcomes.” – Dixon et al., J Am College of Cardiology, 2019
Contemporary psychiatry faces the difficult reality of a history marked by a certain level of complacency with mediocre outcomes. Despite the progress that began in the 1980s with the advent of the DSM system and the antidepressant revolution, the mental health field has not achieved the transformative clinical outcomes that parallel advances in other medical disciplines rooted in biological sciences. This shortfall has resulted in a concerning level of acceptance among both providers and patients for less-than-ideal response rates to psychiatric treatment. Remission, for many, has become a vague aspiration or a serendipitous outcome. Amidst this climate, both therapeutic inertia and its counterpoint—over-treatment—have come to characterize the landscape of psychiatric practice in the United States.
The New Horizon: Advanced Therapeutic Approaches
Despite these setbacks, there’s genuine cause for optimism. Groundbreaking therapeutic approaches like transcranial magnetic stimulation (TMS), esketamine, ketamine, and potentially psychedelics in the near future, bring the promise of a new age of psychiatry. In this evolving landscape, remission of mental health symptoms is becoming the expectation, not the exception. At Mindful Health Solutions, we believe that the most effective way to deliver these next-generation treatments requires both integration and measurement.
Embracing Integrative Care
As the number of new treatment modalities grows, we face the challenge of knowing how to match the right patients to the right treatments and in the right order. But how are interventional treatments currently delivered in the community? Unfortunately, most TMS and ketamine treatments are siloed in specialized clinics focused on only one specific modality (such as a “TMS clinic”). As a result, patients have to navigate a web of private specialty clinics each promoting their favored treatment as the (only) “answer”. And, perhaps more concerning, few mental health clinicians have the training and expertise in multiple treatment modalities to be able to guide their patients through the treatment selection process.
At Mindful Health Solutions, we’ve made it a priority to integrate cutting-edge treatments—like TMS, esketamine, Ketamine Infusion Therapy, and electroconvulsive therapy (ECT)—into our general psychiatry practice. This integration includes both medication management and psychotherapy services. Our clinician-prescribers, who are adept in these advanced treatment options, provide patients with a seamless, comprehensive treatment pathway under one roof, thereby maximizing continuity of care and the probability of full remission.
The Importance of Measurement-Based Care
Access to a wide range of evidence-based treatments is only part of the equation for achieving remission. To truly guide our patients toward optimal mental health, we need a robust, evidence-based treatment pathway built on rigorous measurement. At Mindful Health Solutions, we employ validated scales like the PHQ-9 for depression and the GAD-7 for anxiety at every patient encounter. This data informs our clinicians’ decisions, enabling timely adjustments to treatment plans as needed. Through this meticulous approach, we sidestep the pitfalls of therapeutic inertia, setting our patients on a course for rapid and lasting recovery.
Putting the Pieces Together for a New Era in Psychiatry
With an expanding array of effective treatment options, we now possess many of the puzzle pieces needed to break free from the inertia and nihilism that have long plagued the field of psychiatry. At Mindful Health Solutions, we are committed to assembling these pieces to create a comprehensive, evidence-based approach for our patients and their families. The picture coming into view is very encouraging: Remission is the mission.