Defining a New Era of Mental Healthcare

Adolescence is a pivotal time for mental health, with half of all conditions emerging by age 14. Today, youth mental health stands at a crossroads, as rising rates of anxiety, depression and substance use pose significant challenges to the well-being and future of an entire generation.

For nearly a decade, the team behind the Center for School Behavioral Health has been reimagining school-based mental health support. Schools are uniquely positioned to provide access to this type of care, and students are three times more likely to access care if offered in schools. To date, hundreds of Massachusetts middle, high, alternative and vocational schools have partnered with Massachusetts General Hospital to integrate prevention, early intervention and evidence-based care directly into their educational settings.

“Many mental healthcare systems are designed to react to crisis, but schools are able to intervene upstream and advance access to supports by identifying students who are exhibiting early symptoms. The ultimate goal of mobilizing schools is to alleviate strain on our current system — schools are well poised to help turn the spigot off and reduce the number of kids who need more intensive services down the line,” says Randi Schuster, PhD, founding director of the Center for School Behavioral Health.

By developing and implementing evidence-based interventions, conducting large-scale research studies, innovating workforce solutions, assessing policy mechanisms to support sustainability, and fostering collaborative partnerships with alternative range schools, families and community organizations, the team has built a strong foundation to address key gaps in access to care.

One example of the Center’s success includes its flagship program, iDECIDE™ (Drug Education Curriculum: Intervention, Diversion and Empowerment), which has reached nearly 400 schools, trained 1,500 staff members and reduced student disciplinary actions tied to substance use infractions. In addition, the team has deployed non-clinical interventionists who have screened over 10,000 students statewide, enhancing access to early intervention services and creating connections to further care for both substance use and other mental health concerns.

Since its inception in 2023, the Hispanic Psychiatry Clinic has been improving access to high-quality mental healthcare for monolingual Spanish-speaking patients, while promoting the professional education of psychiatry trainees.

“My colleagues and I conceived of this idea as residents at Mass General,” says Linda Herrera Santos, MD, PhD, director of the Clinic. “We were seeing Spanish-speaking patients in the inpatient unit and the Emergency Department, but not nearly as many in the outpatient setting. We wanted to understand why and bridge this gap.”

Today, the Clinic, which is staffed by psychiatrists and psychiatry residents, cares for about 150 patients. A key part of the Clinic’s success in outpatient care is the referral process with primary care physicians and specialists. By closely collaborating with referring providers, patients receive integrated care that addresses their specific psychiatric needs while considering any underlying medical conditions.

The Clinic also offers training for its residents so they can provide the most personalized mental healthcare possible. As a result, Spanish-speaking patients feel welcomed and are confident they will receive care from someone who not only speaks their language, but also understands their background.

“I’ve had the opportunity to comprehend and contrast experiences rooted in cultural and spiritual dimensions,” Francisco Barrera Flores, MD, psychiatry resident, says of his experience working in the Clinic. “This has facilitated the development of humility, which has been instrumental in fostering deeper relationships with my patients and transitioning toward a more person-centered approach.”

The field of digital mental healthcare has expanded rapidly since the COVID-19 pandemic, when telehealth surged in popularity. Since then, digital support apps have become increasingly common, with more than 20,000 mental health-related apps available to date. However, many of these are not adequate in the information they provide, and users can become disinterested after one use. Furthermore, some apps provide inaccurate or incomplete information because they were not developed in partnership with clinicians or patients.

Galvanized by the potential for new mental health technologies, Sabine Wilhelm, PhD, founded and directs the Center for Digital Mental Health, which was established in 2019 as a think tank in the Department of Psychiatry at Mass General and now has more than 110 members. The Center’s mission is to scale evidence-based technology solutions to prevent, assess and treat mental illness and promote mental health.

“Digital apps can directly address many of the obstacles affecting access to mental healthcare, including stigma, cost and workforce shortage, among others,” says Dr. Wilhelm. “We need to shift away from the old care model, where one person has one therapist they see once a week. We simply don’t have the workforce for that, but technology can provide us with solutions.”

In partnership with patients, designers and engineers, Dr. Wilhelm and her clinical team have developed several apps for mental health conditions including depression, body dysmorphic disorder and obsessive-compulsive disorder. In collaboration with Brigham and Women’s Hospital’s dermatology department, the depression app was also successfully tested in patients with psoriasis and comorbid depression.

“For optimal engagement, we’ve learned that it can be very helpful to include a human element as part of the treatment, and tools like a mood monitor that lets patients track their own symptoms,” says Dr. Wilhelm.

Patient feedback has been overwhelmingly positive for these apps. For example, 100% of patients who have used their depression treatment app, called Mindset Depression, said they would recommend it to a friend with similar problems.

Dr. Wilhelm’s team is also developing and testing the potential of generative artificial intelligence (AI) to support clinicians in delivering more personalized, high-quality therapy. While some patients might see the best outcomes with smartphone-based treatments, others might benefit more from other interventions including face-to-face therapy. Thus, in addition to developing and testing new digital treatments, the Center for Digital Mental Health is working on AI algorithms that allow clinicians to determine which treatment is just right for their patients at a particular moment in time.

Now entering its fourth year, the Focused Integrative Team-Based Treatment for Bipolar Disorder (FITT-BD) program has significantly increased access to treatment for patients with bipolar disorder through a uniquely flexible, collaborative data-driven approach to care. Since its inception, more than 150 patients have enrolled in the program, which is housed within the Dauten Family Center for Bipolar Treatment Innovation.

Three core components anchor the FITT-BD model: stepped (or need-based) care; team-based, collaborative practice; and standardized, systematic measures. In a stepped-care model, patients receive the level of care that corresponds to how they are doing at any given time. This approach allows FITT-BD to treat more patients than traditional weekly, one-on-one therapy, while still providing effective, tailored care.

The collaborative aspect of FITT-BD also distinguishes it from traditional practice. Every FITT-BD patient has a team of providers available to them, including a supervising clinician, patient navigator, psychopharmacologist, neuropsychologist and a peer specialist. All team members meet weekly to review the patient’s progress and discuss treatment modifications.

“FITT-BD is the program I wish I’d had when I was in crisis living with undiagnosed bipolar disorder,” says Sara Schley, author of BrainStorm: From Broken to Blessed on the Bipolar Spectrum. “FITT-BD’s holistic, comprehensive approach is the resource we, as grown children of a mother suffering with excruciating bipolar episodes, longed for, but couldn’t find. FITT-BD is the model that should be scaled and replicated across the country and the world.”