Innovative Treatments for Mental Health Care

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One in every eight adults report having poor mental health, according to a 2018 report from the Washington State Department of Health. Factor in the past few years of the pandemic and other stressors, and that number is likely higher.

Enter the new UW Medicine Center for Behavioral Health and Learning, which opened this spring. To address the need for mental health care throughout the state, the new center offers many different therapies and treatment programs for outpatients, inpatients and civil commitment patients (people who are legally required, after a court mandate, to receive inpatient psychiatric care).

Plus, to help people who may have had trouble accessing care before, the new center offers innovative, game-changing treatments that are proven safe and effective. Here are just a few of them.

Neuromodulation therapies

Neuromodulation is a term applied to many different types of treatments, including deep brain stimulation (DBS), vagus nerve stimulation (VNS) and — the current focus at the new center — electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

“These therapies can be applied throughout the body and brain to modulate (or change) abnormal connections to restore normal communication and function between neurons,” says Randall Espinoza, MD, MPH, director of the Garvey Institute Center for Neuromodulation.

Despite words like “electroconvulsive,” neuromodulation is nothing like the unsafe “shock” therapy of the past.

During ECT, patients are under anesthesia and receive brief electrical stimulation to the brain, which creates a controlled seizure that lasts less than a minute.

During TMS, patients are awake and receive magnetic stimulation to the brain. They are even able to drive themselves home after their appointments if they wish.

“Recent research shows that ECT promotes processes like neuroplasticity and synaptogenesis that are important in restoring normal communication and connections between brain regions that are disconnected or not working well together,” Espinoza says. “This restoration involves changes at the genetic, molecular, neurotransmitter, neuroendocrine, cytokine and neuroinflammatory levels.”

TMS works similarly but uses magnetic instead of electrical energy. It has been approved by the Food and Drug Administration (FDA) since 2008, and ECT has been safely used for even longer. Importantly, the FDA in 2018 reclassified ECT devices into a lower-risk category.

These therapies are approved to treat a variety of mental health disorders like depression, obsessive-compulsive disorder (OCD), and catatonia, a serious complication where a person may not be eating, drinking or moving normally, and for help in smoking cessation. TMS and ECT can also be used when clinically determined to treat bipolar mania, schizophrenia and other disorders associated with serious behavioral complications.

“Eventually, the goal is for other forms of neuromodulation to be developed and offered at the center, including advanced forms of ECT and TMS, VNS, magnetic seizure therapy and DBS, among others,” Espinoza says.

Intensive outpatient program

Sometimes, a patient needs more help than a weekly therapy appointment and medication but doesn’t need to be hospitalized. That’s where the intensive outpatient program comes in.

The program serves adults, including older adults who face challenges managing their mental health conditions, whether due to life transitions such as retirement or loss of a spouse or just typical aspects of aging that make having mental illness harder.

The program involves in-person group sessions, nine hours per week. Group members focus on building coping skills and learning other strategies for managing their mental health. Participants also meet with social workers regularly for progress review, see a psychiatrist for medication management, and have opportunities for individual therapy sessions with a psychologist. The program lasts approximately twelve weeks.

“It’s a place where people can learn they aren’t alone,” says Koriann Cox, PhD, the licensed clinical psychologist who leads the program. “We teach them that their life can be different if they want it to be, that they can’t always change big structures of their life, but they can change how they engage with those structures.”

Family and caregiver support program

One aspect of mental health care that is often overlooked is the important role of patients’ families or caregivers. Not only can they benefit from reliable information and education about their loved one’s mental health condition, but the more they know about mental health care, the more they’re able to help and support their loved one.

The Family and Caregiver Training and Support (FACTS) Program, launched in September, is a resource for families and caregivers who are helping an adult loved one navigate mental health treatment.

The program is being developed by Mollie Forrester, MSW, LICSW, director of Patient and Family Experience for the Department of Psychiatry and Behavioral Sciences. The FACTS website includes information, resources and skills training for families and caregivers of adult patients being treated at the Center for Behavioral Health and Learning. The first skills training, currently in a pilot phase, focuses on foundational communication skills. The modules are offered online and on-demand, meaning families and caregivers can take the course on their own time whenever is most convenient.

Once the pilot is complete, Forrester hopes to make the curriculum publicly available to UW Medicine more broadly and eventually to the general public.

“Inclusion, information, support, resources, skills — over and over, families say this is what they need,” Forrester says.

Families and caregivers will be able to provide input on the communication skills training during the pilot phase as Forrester, psychiatrist Anna Ratzliff, MD, and their team fine-tune the details.

Building skills families can use to communicate with their loved ones is a core part of the program, and Forrester emphasized that these skills will be taught in a way that is applicable no matter a patient’s specific mental health diagnosis or situation. She hopes to add additional training and support services as the FACTS program grows and as funding allows.

Learn more about the Center for Behavioral Health and Learning.