Healthcare Reforms for the Mentally Ill

Catalyst VOlume 10

Neuropsychiatric illnesses are some of the most devastating conditions in the world. Despite being non-communicable, mental and neurological conditions are estimated to contribute to approximately 30.8% of all of the years lived in disability1. Furthermore, in developed nations like the United States, mental disorders have been reported to erode around 2.5% of the yearly gross national product, which fails to account for the opportunity cost of families who have to take care of patients long-term.¹ If left untreated, many patients with neuropsychiatric illnesses cannot find gainful employment; their aberrant behavior is stigmatized and prevents forward professional and personal advancement. In fact, about three times as many individuals living with mental illnesses who are in state/local prisons rather than rehabilitative psychiatric institutions.²

Though the Affordable Care Act has substantially decreased the amount of uninsured individuals in the U.S., there are still millions of people who fall into something called the Medicaid gap.³ People in this group make too much money for Medicaid, but too little money to be able to qualify for government tax credits in purchasing an insurance plan. In an attempt to fix this ‘hole,’ the federal government offers aid to states in order to expand their Medicaid programs as needed.⁴ States that have accepted the Medicaid expansion sponsored by the federal government, have seen sudden reductions in their populations of uninsured people, which has directly improved quality of life for the least fortunate people in society. However, in the many states that continue to reject federal aid, the situation is considerably worse--especially for the mentally ill.

Mental health patients are especially vulnerable to falling into the Medicare gap. Many patients suffering from psychiatric conditions often are unable to find serious employment. According to a report by the Department of Health and Human Services in March 2016, there are 1.9 million low-income, uninsured individuals with mental health disorders who cannot access proper healthcare resources.⁵ These impoverished psychiatric patients are originally eligible for Medicare. However, once their treatment takes and they become employed, they might pass the Medicare income threshold. If their private health insurance does not cover the cost of their psychiatric treatments, patients will relapse, creating a vicious cycle that is exceptionally difficult to break out of.⁶

Furthermore, many psychiatric illnesses often initially present during adolescence or early adulthood, which is right around the time students leave home to go to college. So, during initial presentation, many students lack the proper support system necessary to deal with their condition, causing many to drop out of college or receive poor grades. Families often chalk up these conditions to poor adjustments to a brand new college environment at home, preventing psychiatric patients from properly receiving treatment.⁶ Alone, many students with psychiatric conditions delay seeking treatment, fearing being labeled as “crazy” or “insane” by their peers.

Under the status quo, psychiatric patients face significant barriers to care. As the Medicaid gap is unfortunately subject to political maneuverings, it probably will not be fixed immediately. However, the United States could fund the expansion of Assertive Community Treatment programs, which provide medication, therapy, and social support in an outpatient setting.⁸ Such programs dramatically reduce hospitalization times for psychiatric patients, alleviating the costs of medical treatment. Funding these programs would help insurance issues from being a deterrent to treatment.

In the current system, psychiatric patients face numerous deterrents to receiving treatment, from lack of family support to significant social stigma. Having access to health insurance be a further barrier to care is a significant oversight of the current system and ought to be corrected.

References

1. World Health Organization. Chapter 2: Burden of Mental and Behavioural Disorders. 2001. 20 3 2016 <http://www.who.int/whr/2001/chapter2/en/index3.html>.
2. Torrey, E. F.; Kennard, A. D.; Elsinger, D.; Lamb, R.; Pavle, J. More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States .
3. Kaiser Family Foundation. Key Facts about the Uninsured Population. 5 8 2015. 25 3 2016 <http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/>.
4. Ross, Janell. Obamacare mandated better mental health-care coverage. It hasn't happened. 7 8 2015. 24 3 2016 <https://www.washingtonpost.com/news/the-fix/wp/2015/10/07/obamacare-mandated-better-mental-health-care-coverage-it-hasnt-happened/>.
5. Dey, J.; Rosenoff, E.; West, K. Benefits of Medicaid Expansion for Behavioral Health. 28 3 2016 <https://aspe.hhs.gov/sites/default/files/pdf/190506/BHMedicaidExpansion.pdf>
6. Taskiran, Sarper. Interview. Rishi Suresh. Istanbul, 3 3 2016.
7. Gonen, Oner Gurkan. Interview. Rishi Suresh. Houston, 1 4 2016.
8. Assertive Community Treatment https://www.centerforebp.case.edu/practices/act (accessed Jan 2017).

Haptics: Touching Lives

Catalyst Volume 10

Everyday you use a device that has haptic feedback: your phone. Every little buzz for notifications, key presses, and failed unlocks are all examples of haptic feedback. Haptics is essentially tactile feedback, a form of physical feedback that uses vibrations. It is a field undergoing massive development and applications of haptic technology are expanding rapidly. Some of the up-and-coming uses for haptics include navigational cues while driving, video games, virtual reality, robotics, and, as in Dr. O’Malley’s case, in the medical field with prostheses and medical training tools.

Dr. Marcia O’Malley has been involved in the biomedical field ever since working in an artificial knee implant research lab as an undergraduate at Purdue University. While in graduate school at Vanderbilt University, she worked in a lab focused on human-robot interfaces where she spent her time designing haptic feedback devices. Dr. O’Malley currently runs the Mechatronics and Haptic Interfaces (MAHI) Lab at Rice University, and she was recently awarded a million dollar National Robotics Initiative grant for one of her projects. The MAHI Lab “focuses on the design, manufacture, and evaluation of mechatronic or robotic systems to model, rehabilitate, enhance or augment the human sensorimotor control system.”¹ Her current research is focused on prosthetics and rehabilitation with an effort to include haptic feedback. She is currently working on the MAHI EXO- II. “It’s a force feedback exoskeleton, so it can provide forces, it can move your limb, or it can work with you,” she said. The primary project involving this exoskeleton is focused on “using electrical activity from the brain captured with EEG… and looking for certain patterns of activation of different areas of the brain as a trigger to move the robot.” In other words, Dr. O’Malley is attempting to enable exoskeleton users to control the device through brain activity.

Dr. O’Malley is also conducting another project, utilizing the National Robotics Initiative grant, to develop a haptic cueing system to aid medical students training for endovascular surgeries. The idea for this haptic cueing system came from two different sources. The first part was her prior research which consisted of working with joysticks. She worked on a project that involved using a joystick, incorporated with force feedback, to swing a ball to hit targets.² As a result of this research, Dr. O’Malley found that “we could measure people’s performance, we could measure how they used the joystick, how they manipulated the ball, and just from different measures about the characteristics of the ball movement, we could determine whether you were an expert or a novice at the task… If we use quantitative measures that tell us about the quality of how they’re controlling the tools, those same measures correlate with the experience they have.” After talking to some surgeons, Dr. O’Malley found that these techniques of measuring movement could work well for training surgeons.

The second impetus for this research came from an annual conference about haptics and force feedback. At the conference she noticed that more and more people were moving towards wearable haptics, such as the Fitbit, which vibrates on your wrist. She also saw that everyone was using these vibrational cues to give directional information. However, “nobody was really using it as a feedback channel about performance,” she said. These realizations led to the idea of the vibrotactile feedback system.

Although the project is still in its infancy, the current anticipated product is a virtual reality simulator which will track the movements of the tool. According to Dr. O’Malley, the technology would provide feedback through a single vibrotactile disk worn on the upper limb. The disk would use a voice coil actuator that moves perpendicular to the wearer’s skin. Dr. O’Malley is currently working with Rice psychologist Dr. Michael Byrne to determine which frequency and amplitude to use for the actuator, as well as the timing of the feedback to avoid interrupting or distracting the user.

Ultimately, this project would measure the medical students’ smoothness and precision while using tools, as well as give feedback to the students regarding their performance. In the future, it could also be used in surgeries during which a doctor operates a robot and receives force feedback through similar haptics. During current endovascular surgery, a surgeon uses screens that project a 2D image of the tools in the patient. Incorporating 3D views would need further FDA approval and could distract and confuse surgeons given the number of screens they would have to monitor. This project would offer surgeons a simpler way to operate. From exoskeletons to medical training, there is a huge potential for haptic technologies. Dr. O’Malley is making this potential a reality.

References

1. Mechatronics and Haptic Interfaces Lab Home Page. http://mahilab.rice.edu (accessed   Nov. 7, 2016).
2. O’Malley, M. K. et al. J. Dyn. Sys., Meas., Control. 2005, 128 (1), 75-85.