Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And today, we're excited to highlight the launch of the Dauten Behavioral Health Institute at Northwestern Medicine. Joining me is Dr. Sachin Patel. He's the Chair of the Department of Psychiatry and Behavioral Science. He's the Director of the Stephen M. Stahl Center for Psychiatric Neuroscience, and a Lizzie Gilman, Professor of Psychiatry and Behavioral Science at Northwestern Medicine.

Dr. Patel, it's a pleasure to have you with us. This is a really exciting time for Northwestern Medicine with the launch of the Dauten Behavioral Health Institute. Tell us a little bit about how the institute will strengthen and broaden the care provided at Northwestern Medicine, and especially for patients with complex psychiatric conditions. Why is this, Dr. Patel, the right moment for Northwestern to launch this dedicated institute?

Sachin Patel, MD: So, this is indeed an exciting time. And there's lots of reasons why this is happening now. I mean, as you probably know and most listeners know, you know, access to behavioral health and mental health care services is sort of at an all time high. There's, you know, a shortage of providers. And, as you also may know, my arrival here several years ago to Northwestern and beginning conversations with the Dauten family who is helping us launch this institute really puts us in a good place to think about what the future of mental health care at Northwestern Medicine could look like.

And so, what this means is potentially a game changing way of delivering mental health care services at Northwestern Medicine across the range of services. So, complex psychiatric disorders, including bipolar disorder, is going to be one of the main focuses of the institute. And I can talk a little bit about that in a second. But this really more broadly represents putting behavioral healthcare and mental health services at the forefront of Northwestern Medicine in a way that it hasn't been before. And the launching of the institute really represents an investment from, of course, the Dauten family, but also Northwestern Medicine and making sure that our patients have access to the highest quality mental health care services with fast access to care when patients need it.

Melanie Cole, MS: That's certainly so important, especially now. This is just a really interesting topic, but so needed. So, how do you see, Dr. Patel, clinical and research teams collaborating more or differently under this new framework? How do you see this happening?

Sachin Patel, MD: Right. So, the institute is a great opportunity for us to be thinking holistically about patient care, access quality, but also research in terms of next generations of treatments and clinical trials. And more importantly, or as importantly, certainly is the basic understanding of some of these psychiatric disorders, which are, you know, at this point quite elusive. So, the institute really is going all the way from patient care to clinical research and even some foundational research into mental health. And it's a comprehensive institute structure.

So, what we're thinking about is designing clinical programs that integrate research into our clinical framework in a way that we haven't really been able to do in the past, and that's what's really exciting. So, having the opportunity to launch an institute that spans both discovery and care and doing that in a synergistic way in terms of recruitment of new faculty that are involved in research, but also clinical care and clinical trials, and also thinking about new ways that we can design our clinical programs so that they really synergize with those research platforms in terms of recruitments for subjects for clinical trials, for example.

So, it's a great way to rethink how we deliver care, do research, and really fundamentally practice psychiatric care here at Northwestern. So, it's extremely exciting.

Melanie Cole, MS: And you mentioned bipolar disorder. So, how will Northwestern Medicine's Bipolar Disorder Center of Excellence—what sets it apart, Dr. Patel, from other national programs in how it approaches diagnosis and treatment, research you just mentioned? Speak a little bit about what makes it so unique.

Sachin Patel, MD: Sure. So, as part of our larger sort of strategic plan for mental healthcare services, we have identified several specific areas as sort of destination programs where we can attract, you know, patients from the region and beyond for a specialty level of care. And we have some of these areas already established, but the new institute allows us to really focus on one that we haven't yet had major ground in, which is of course, bipolar disorders.

And so, the new Center for Excellence is going to be focused on high-quality care, diagnostic multidisciplinary teams, access to wraparound services for both patients and families. So, it's a holistic approach to, you know, a complex disorder, as you mentioned. And what it aims to do is really provide levels of care to both patients and families that go far beyond what is sort of generally accepted in the community at this point.

And so, that's what's going to make this the destination for people that have either difficulty in terms of an accurate diagnosis or refractoriness to current treatments. And are looking for either clinical trials to participate in or are looking for additional psychosocial educational occupational services that help people thrive with bipolar disorder. And that's really what would set this program apart.

Melanie Cole, MS: Dr. Patel, as behavioral health outcomes as we know, these can be really difficult to quantify and somewhat subjective, depending on the patient. So, how will the institute define and measure success? How will these clinical outcomes and the registry shape real-time decision-making? And what early metrics do you feel matter most?

Sachin Patel, MD: Right. So, as some of the listeners might know, you know, psychiatric illnesses are really defined through people's subjective experience, which makes it quite different from some other types of illnesses, at least at this point in time. And so, developing well-established sort of nationally validated metrics for symptom improvement, for example, provides us with a quantifiable measure of how we are actually helping patients. And so, this has been something that has been a push nationally and something that the institute is going to allow us to invest in, using information technology approaches. So, integrating these metrics and quantifiable measures of patient's symptoms and how they improve through treatment in our program will really be one of the main tools that we can use to gauge how successful is our program. The patient registries will be integrating with our electronic medical record that really allow us to, for example, preemptively identify people that may not be receiving the highest level of care appropriate to their diagnosis or symptom severity, and alert physicians, for example, that they might need to intervene.

Other ways that this could be useful is to pre-identify people that may have laboratory abnormalities because of the medication they're taking or their underlying disease that require some sort of intervention. So, really amplifying the ability of these digital interventions. And the electronic medical records really help us do better is really one of the most exciting aspects of this. And developing the registry and developing the clinical dashboards to help us identify people that need intervention earlier and make sure actually we're, you know, getting the outcomes we believe that we should be getting are quite exciting and allow us to really have a compelling story around why this program is the best possible space for patients in the area.

Melanie Cole, MS: Well, so then, along that lines, and in the day and age that we are in now, Dr. Patel, what role will digital therapeutics, telepsychiatry, AI-enabled screening play in this roadmap, in this vision? How do you balance innovation with the very human, relationship-driven nature of behavioral healthcare?

Sachin Patel, MD: Yeah. Actually, that's a great question. Of course, I believe, and you know, many of our providers really believe, as you just mentioned, the core of the therapeutic alliance is really person to person, whether that's with physicians, psychotherapists, occupational therapists, and others. But what we're hoping to do is leverage the technology to make those interactions more productive to, for example, identify, as I mentioned before, people before they exhibit a relapse of mania or depression, for example, and can there be digital indicators that alert us that a particular patient needs something more than they're getting currently?

Other approaches including sort of self-help and digital-based, app-based approaches to provide care and support for patients in between visits is another way in which that information technology can augment something that is, again, fundamentally based between a provider and a patient.

Melanie Cole, MS: Yeah, certainly. I mean, the advances are happening so quickly now, that it is exciting to see how some of this can really fall into place. Will peer support, for example, employment support, collaborative care models be integrated into this day-to-day psychiatric practice or special programs? What role will collaborative care models play in this vision?

Sachin Patel, MD: So, a large role. So currently, our collaborative care program is primarily focused on depressive disorders, anxiety disorders. But as we launch the institute and focus on expanding our care and specialty care areas in bipolar disorder, that also will be a service that now will be expanded into our collaborative care program, providing patients some degree of access to specialized services through their primary care provider. So, that is going to be launched very soon.

Peer support, occupational therapy, educational support are all critical aspects of a comprehensive clinical care program. And those are the types of things that really will set apart a center of excellence, for example, from kind of the standard care of going to a doctor every few months or so, right? These additional components including family therapy, for example, especially for people with new onset illness, in terms of helping families understand what is bipolar disorder, what are treatments for bipolar disorder how can families be helpful in terms of helping their, you know, siblings, children cope with disorders.

And so, all of those types of things are thought to really provide something quite unique and represent really a major thrust of what the institute will allow us to do.

Melanie Cole, MS: Well, that certainly is comprehensive. And that multidisciplinary approach for family care and, as you say, occupational therapy, it all comes together. Now, how does a gift of this scale, Dr. Patel, allow you to pursue innovations or care models that traditional funding structures typically can't support? One example might be how will you reach patients that typically fall through the cracks? I mean, there's so much to this question.

Sachin Patel, MD: There is a lot. And I think the last one is easier to answer first in terms of all of these support services such as educational support, for example, that are critical for people in their late teens and early 20s as they're struggling with the onset of a bipolar illness that can often derail their educational trajectories and providing those educational support services to get people back on track is something that we can do really without cost to patients, right, because of gifts like this.

So, those are the types of things that really will attract patients to the center of excellence and give them a really unique advantage in terms of living with, coping with and, ultimately, thriving with bipolar disorder and getting them back on their life trajectories that they had before onset.

So, again, being able to provide that peer support, educational, occupational support, family counseling free of charge, sort of outside of the normal scope of sort of the way our medical system currently runs, that's really exciting for us as providers but also, of course, for the patients that are going to benefit from that.

And so, a gift of this scale allows us to do, of course, a lot more than simply focus on bipolar disorder. So, one of the things that we're very interested in doing is expanding innovative care models. So, how do we provide patients with faster access to care, which is a big problem across the country in terms of waitlists and the ability to, you know, find providers for psychiatric care. And so, gifts like this allow people with great ideas to sort of help materialize those and, if successful, promote those and really distribute them throughout our health system. And some of those pilot projects are ongoing. And indeed, actually a large portion of this gift is focused on clinical innovation.

So, these really allow us to put high-risk ideas on the table that could potentially have transformative impact for patients and test them in an iterative way until we feel like they're ready for, you know, for prime time, and then help our colleagues by distributing them to other parts of our health system.

Melanie Cole, MS: That's so important. And Dr. Patel, as we get ready to wrap up, for peers who may want to collaborate or refer, what would you like them to know right now about the Dauten Institute? And what do you feel are the most exciting advances? What's your vision as you're to look forward for the other peers listening? What's exciting? What is your vision on the horizon?

Sachin Patel, MD: So, one of the things that we're very focused on, and that was entirely enabled through the Dauten gift was to really establish a Midwest Center for brain stimulation for mood disorders and bipolar disorders, which involve recruitment of new scientists and clinical researchers to the department. So, that to me is extremely exciting.

So, non-invasive brain stimulation has gained a lot of traction over the past several years. It's something that's easily accessible, lower cost, and, again, non-invasive to patients. And some of the new faculty that are joining our department are going to be leading these clinical trials and ultimately, we believe, will be potentially transformative for bipolar disorder and other illnesses. And that would be entirely due to the fact that we have, you know, these very large resources from the Dauten Institute to really push those types of innovations forward.

Melanie Cole, MS: Thank you so much, Dr. Patel, and congratulations, because this is really a great initiative. And thank you for telling us all about it. And to refer your patient or for more information, visit our website at breakthroughsforphysicians.nm.org/psychiatry to get connected with one of our providers. And that wraps up this episode of Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole.