Is The Mental Health System Broken Or Was It Never Built To Work?

Forbes

3 days ago

Five years ago, a research team at Stanford achieved what many in psychiatry had long hoped for: A treatment for severe depression that worked rapidly, reliably, and without medication. In their 2020 SAINT trial, 19 out of 21 participants with treatment-resistant depression achieved remission after just five days of transcranial magnetic stimulation (TMS). It was a landmark moment.
Yet today, the treatment remains almost entirely inaccessible to the average patient. Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) is still paid for out of pocket, costing roughly $20,000, and insurers have been slow to move.
A paradox at the heart of American mental healthcare: as innovation accelerates, access stalls. Over the last five years, more than $13 billion has been invested in the sector, but outcomes haven't improved in kind. Patients still cycle through multiple failed treatments. Clinicians are burnt out, and payers are stuck making decisions with no data.
It's tempting to say the system is broken. But perhaps it was never built to do what we're now asking of it.
A System Built for Simplicity, Not Reality
Modern mental healthcare still relies on a medical model designed for acute illness: assess symptoms, assign a diagnosis, and prescribe a standard treatment. It's a linear approach that works well for infections and injuries. But mental illness is not linear.
A messy intersection of biology, trauma, environment, and social context shapes conditions like depression, PTSD, and OCD. There's no single cause, no universal treatment. And yet, the system continues to reduce people to diagnosis codes and protocol templates, often leaving naivety at the door.
This reductionist model doesn't reflect the complexity of the human experience, and it leaves patients, clinicians, and payers with more questions than answers.
The system doesn't work for anyone. Yet, the misalignment of incentives means that all stakeholders are working against one another. Payers prioritize risk management—and in the absence of meaningful data, default to spending as little as possible. Providers focus on individual outcomes. Pharma chases scalable efficacy. Patients just want relief. But it seems no one is working with the correct information, and the frustration and disappointment are palpable.
Data alone doesn't matter, because it's about how you use the data to drive change, according to Brayden Efseroff, psychiatrist and Chief Medical Officer at Allia Health. 'When patients cycle through multiple failed treatments before finding relief, it's not just frustrating - it's a sign of systemic dysfunction. Decisions are being made without context.'
Ariel Ganz, PhD, a precision mental health researcher at Stanford, agrees, 'The same data clinicians need to design effective treatment plans is also critical for payers to manage risk, researchers to improve understanding, and patients to advocate for themselves on their health journey. 'Without more high-quality data, none of these parties can effectively improve patient outcomes.'
Precision Mental Health Company is addressing this issue at its core. Their AI-native electronic health record (EHR) isn't designed to replace therapists or psychiatrists, but to support them by capturing, organizing, and translating real-world data into usable, structured insights. This innovative solution holds the promise of a brighter future for mental healthcare.
Instead of extracting revenue from clinicians through software subscriptions or taking a percentage of their reimbursement, payers partner directly with Allia on value-based contracts. They're paid only when patients achieve measurable improvements, a stark contrast to the fee-for-service model that rewards volume over outcomes.
Amie Leighton, CEO of Allia Health, discovered the need for better data firsthand during years of cycling through hospitals and treatment before finally receiving adequate care. The turning point came when her clinicians had access to complete information about her and were able to communicate with each other - something that had been missing throughout her previous treatments. This personal experience, and the empathy it engenders, shaped the company's mission: to build the infrastructure that allows for context-rich, coordinated, and personalised care.
The Bigger Picture
How do you fix a system that was never designed to work in the first place? We still have a long way to go, but for the millions of Americans struggling with mental health challenges, finally, an infrastructure-first approach offers something that's been missing: a system designed to actually help people recover. In an industry where patients commonly endure multiple failed treatments before finding relief, this represents a significant shift toward care that prioritizes outcomes.