Innovating for the mental health of Minnesotans

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I was excited to read about Allina’s expansion of access to transcranial magnetic stimulation (TMS) for depression at its new facility in Fridley (front page, July 1), and dismayed but not surprised to see that Minnesota mental health patients stay 25 hours longer than necessary in the emergency department awaiting needed treatment (front page, July 23). Those unnecessary stays affect all patients needing emergency care.

Many of us predicted a global mental health pandemic would follow COVID-19. This wave is affecting our emergency departments and hospitals, as well as our schools and workplaces. Clearly, we need more effective mental health treatments such as TMS and we need to get better at early prevention and intervention. The brain is the most complex human organ and we already know that the conventional medical approach — lab tests identifying a singular disease process leading to medication and/or surgery — cannot be applied simplistically to mental illnesses.

That is driving the University of Minnesota Medical School’s approach to move beyond conventional treatments with approaches such as TMS, where a magnetic coil on the surface of the head induces a beneficial electric current in the brain. This successful, innovative approach to the complexities of severe depression emerged from clinical trials conducted in the early 2000s by Dr. Ziad Nahas, a professor at the Medical School. In collaboration with other scientists in neuroengineering, surgery and the Masonic Institute for the Developing Brain, Nahas and team are now pioneering new treatment discoveries not just for mental illnesses but for understanding how the brain and the body talk to each other through the nervous system to affect overall health and well-being.

Successful unconventional approaches like these occur when motivated individuals from different backgrounds come together to think creatively — the ethos of our medical school, especially when it comes to mental illness. Not many other places are home to a research lab co-directed by a young psychiatrist with a degree in engineering and a young neurosurgeon with degrees in physics and public health.

It’s important to note that innovative high-tech brain stimulation by itself will not be a miracle cure. The person who is no longer crushed by debilitating depression needs to learn new, low-tech but critically important ways of defining themselves and interacting with the world, a key focus of our Treatment-Resistant Depression clinic, where high-tech and low-tech approaches live side-by-side.

Likewise, we’ve learned that when a young person goes through the frightening and overwhelming experience of a first episode of psychosis, it is not enough to just prescribe meds that reduce symptoms and then send the patient on their way. If we can provide additional specialized (low-tech) counseling that fosters the individual’s resilience and motivation and strengthens the family’s understanding of the illness, along with professional support for returning to work or school, we improve recovery, reduce future hospital stays and keep patients out of the emergency department.

With strong support from NAMI Minnesota, the Minnesota Department of Human Services funded five teams to use this approach in the Twin Cities and Duluth; our team at the medical school went on to obtain a grant from the National Institute of Mental Health to link these clinics together into a regional network so we can learn from one another, and more importantly, connect to similar networks around the U.S. as part of a national research database to improve early intervention and prevention in psychosis.

In our Minnesota network, we have discovered recently, counter to earlier concerns, that providing detailed and personalized digitally acquired measures of psychological and brain function to patients, along with a social networking app, deepens their self-knowledge and helps them achieve more recovery goals. We are sharing these findings nationally and internationally to others who work in this field.

Our unconventional thinking doesn’t stop here. We are deeply aware that Minnesotans who live outside the metro area lack access to these innovations. The state Department of Human Services recently funded our plan for a hybrid early psychosis clinic that can offer specialized services to greater Minnesota, while Dr. Nahas is planning to create a mobile TMS unit that can travel to underserved areas and work with local clinics to provide this life-changing treatment. As we say, think globally but act locally — a motto we pursue for the mental health of Minnesota and beyond.

Dr. Sophia Vinogradov is a professor and chair of the Department of Psychiatry and Behavioral Health at the University of Minnesota Medical School.