Is mental health care stuck in the past?

In today's society, innovation is very important. It is rather strange then, that innovation in mental health care is lacking.  

An internist who retired 30 years ago would have to study hard to be able to get back to work today. If he still treated his patients the same way he did 30 years ago, he would run into trouble in no time. The same holds for an oncologist, a neurologist or a rheumatologist.

However, a psychiatrist or psychologist would have less trouble starting again today: today’s treatments for psychological and psychiatric problems are still very much the same as they were in the 1980s. In psychiatry, it seems as if time has stood still. 

I would like to share with you the following two examples:

ADHD treatments

ADHD is diagnosed when you meet certain criteria, such as hyperactivity, impulsivity, problems with concentrating, and an "overactive" brain. If you meet these criteria, you will probably get the advice to take medication like Ritalin. Sometimes you will get a referral to seek psychological help, like cognitive behavioural therapy.

"ADHD" is the name we have given to this collection of complaints, but it is not the cause of these complaints. A Dutch research group suggests that sleep problems play a central role. Sleep problems are not part of the official criteria of ADHD, but it has been known for some time that the vast majority of people with ADHD suffer from sleep problems.

For example, about 70 percent of children and adults with ADHD have difficulty falling asleep in the evening and find it difficult to get going in the morning. Often, they have these difficulties from a very young age. Other people with ADHD have subtle breathing problems during their sleep or have restless legs at night.

These sleep problems can lead to concentration problems during the day, memory problems and diminished control over impulses. And every parent knows what happens to children when they are tired: they become hyperactive. This is exactly the combination of symptoms that is labelled as "ADHD".

This also explains why ADHD drugs like Ritalin have a calming effect on many people with ADHD, while these drugs have a stimulating effect on other people: they make the sleepy brains of people with ADHD wake-up for a while. Waking up a sleepy brain with medication can work fine, but it remains symptom control.

It can be interesting, and this means stepping away from the "old school" approach, to analyse the sleep and brain activity of children and adults who meet the criteria of ADHD. There are techniques that can help us with this, like neurofeedback, which is a relatively new method. This method has produced very good results after training the brain to reduce abnormal brain activity.

Depression treatments

Depression is one of the most common, invalidating and complex mental health problems of all times, causing a lot of distress for all involved. In the treatment of depression though, we see the same stagnation as outlined before. The focus of physicians and other professionals is still mainly on medication and if that doesn’t work, psychological treatment is advised. At the end of the treatment road, electroshock therapy is an option.

Of course, medication helps in a lot of cases, but sometimes it only helps for a while and it can cause many side effects. That also goes for electroshock therapy unfortunately: it helps in a lot of cases, but it can cause severe and lasting side effects. Psychotherapy is not always successful, so there must be alternatives available nowadays? Targeting biology, cognition and behaviour at the same time?

There is growing evidence that a combination of psychotherapy with magnetic brain stimulation (rTMS) is safe and has better outcomes than the available monotherapies, without causing (major) side effects. But this treatment is not yet on the map for a lot of people. 

Innovation takes time

I have noticed that innovation in mental health care takes more time than you would expect in 2019, a year in which there are self-driving cars, robots to operate on us and help us in the household, and virtual reality instead of an estate agent when we look for a new apartment.

Of course, it is not a black and white matter as clinicians are experimenting more with e-health and online treatments. This is a good thing, but I believe we can do more.