The World Health Organization has projected depression to have the largest global burden of disease by 2030 (it's currently ranked third).

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To meet rising rates of mental health issues, clinicians need to use evidence-based practices and measurement-based care (MBC), which mental health leaders have been recommending for decades.

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A large body of research has shown that measurement-based care (MBC) can improve clinical outcomes and provide a number of benefits to both providers and patients in mental health care:

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• Improve patient outcomes and significantly increase the therapeutic effect size

• Detect symptom deterioration faster and increase rates of detection

• Increase therapeutic efficiency - faster symptomatic improvement

• Detection of acute situations

• Increase patient adherence to medication and treatment protocols

• Patients feel more engaged and informed and in control

• Patients are more in tune with their own progress and recognize early signs of relapse or promising signs of improvement

• Patients find that this approach improves the therapeutic relationship with the provider and enhances communication

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Despite MBC's benefits, only 18% of Psychiatrists and 11% of therapists implement MBC in their practice, citing obstacles such as extra time for no extra reimbursement.

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In this guide to measurement-based care, we’ll cover the benefits of MBC to mental health clinicians and patients, and how to easily implement MBC in your practice.

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What is Measurement Based Care?

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MBC is an evidence-based practice that refers to the systematic evaluation of patient progress throughout a treatment, including systematic administration of symptom rating scales, which helps drive clinical decision-making in a personalized manner. MBC has been shown in the literature to be important for enhancing mental health care outcomes [4]. Mental health providers should use measurement-based care (MBC), which evidence has shown improves clinical outcomes, therapeutic efficiency, and patient adherence.

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The use of validated measures does not replace clinical judgment, but rather augments it. MBC is really important because it allows providers to detect if a patient is not responding well to treatment.

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Without MBC, providers detect clinical deterioration for only about 20% of patients who’ve experienced an increase in symptom severity, resulting in poor outcomes [8].

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Accurately measuring health outcomes in the mental health space is not as straightforward as it might be in fields like cardiology—where there are more definitive metrics like blood pressure.

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However, this doesn’t mean there’s nothing that can be done to improve the accuracy of mental health tracking.

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By improving how we measure mental health, we can:‍

• Develop better insight into treatment progress

• Reduce symptom deterioration

• Improve patient outcomes

[4–6]

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Measurement-based Care (MBC) in psychiatry empowers clinicians to focus on the individual needs of their patients by systematically measuring patient-reported outcomes [7].

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This involves the routine administration of validated assessments of clinical outcomes—usually completed electronically by the patient.

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Clinicians and patients can then view a summary of the results. Both the clinician and the patient can then review this data and use it to aid in clinical decision-making.

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How Mental Health Rating Scales are used in Measurement-Based Care

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There are a number of validated mental health rating scales. Research has shown that patient-reported symptom rating scales are as accurate as rating scales administered directly by clinicians in their ability to determine whether someone is responding to the treatment [9].

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Such scales have been empirically validated and improve the efficiency, accuracy, and consistency of symptom tracking by providers. Validated scales exist for most psychiatric disorders.

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Many studies have shown that MBC improves patient outcomes and engagement [7, 10–32].

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• Research shows that formal, ongoing feedback to therapists from their clients nearly doubled their therapeutic effect size [33].

• Measuring patient progress can lead to twice as many patients improving [18].

• A large number of randomized controlled trials have consistently and robustly shown that MBC results in better clinical outcomes in both psychiatry and psychotherapy [22, 34–40].

• The authors of one review article that examined over 50 studies wrote, “Virtually all 3 randomized controlled trials with frequent and timely feedback of patient-reported symptoms to the provider during the medication management and psychotherapy encounters significantly improved outcomes” [10].

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MBC also improves treatment efficiency

The use of MBC to track outcomes for patients receiving cognitive-behavioral therapy has also been shown to lead to faster symptomatic improvement [41, 42].

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Research also shows that MBC helps clinicians respond more quickly and effectively to issues experienced by their patients [43].

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MBC works because providers can combine their clinical judgment with quantitative and qualitative measures on their patients’ progress.

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MBC allows you to detect symptoms, acute emergencies, and improvement. It gives you an objective source of truth to coordinate and collaborate on care.

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‍Research has shown that patients find MBC to be helpful [44].

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By openly discussing adherence or progress with the patient, MBC helps to create a sense of control over their own health outcomes. Patients can monitor early signs of relapse or promising signs of improvement. This encourages sustained motivation and adherence to medication and treatment protocols.

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Additionally, MBC can reduce no-show appointments[49].

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Ultimately, MBC improves treatment outcomes and strengthens the therapeutic relationship. Patients see MBC as evidence that providers care about them and take their mental health seriously. They appreciate receiving feedback and feel that MBC fosters better communication, which further increases engagement [31, 45–48].

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Patients find that MBC helps them better understand their own condition, helps them convey information about their mental health to their provider, and simply adds efficiency to the care journey [44].

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MBC takes the guesswork out of progress monitoring. Many research studies utilizing large real-world trials have shown that clinicians feel MBC is feasible and preferable for:

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• Monitoring response to treatment
• Evaluating illness severity
• Monitoring suicide risk
• Making treatment decisions

[50–53]

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We're witnessing a great resurgence of clinical interest in the use of psychedelic medicines [55–59].

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While there's single definition for psychedelic medicines, one commonly used criterion is the primary mechanism of action for these compounds involves the agonism of 5HT-2A receptors in the central nervous system.

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For our purposes here, we shall expand our criteria to also include ketamine (which has a different mechanism of action involving glutamate and opioid receptors [60]) and related molecules, and more broadly any compound whose therapeutic mechanism of action involves psychoactive or hallucinogenic states.

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In this framework we're using here, therapeutic benefits of psychedelic medicines can arise from either:

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1) drug-induced biochemical changes exerted on receptors and cells, and/or

2) a combination of psychoactive experience and psychotherapy.

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Measurement-based care can bridge the gap between clinical trials and real-world data collection for innovative treatments.

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Over the last few years, many randomized controlled trials have shown that psychedelic medicines can effectively treat diseases such as treatment-resistant depression, post-traumatic stress disorder, and substance use disorder (for a few examples, see [61–64]). A large body of research evidence is accumulating and a number of other indications are also being explored with promising early results.

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Despite exciting research, there is still work to be done before the potential of these therapies can be fully realized. Since psychedelic medicine is still in its early days, clinicians will need to know how their patients’ improvements will change over time.

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Questions to be explored in clinical practice:

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• Does the treatment effect persist, or does it wane after several weeks, months, or years?

• How do patients fare between treatments?

• Even if clinicians wanted to answer these questions, how would they effectively measure outcomes in a novel space?

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These are new therapies and few practicing clinicians have been formally trained to use them. Even with training, we know that using just judgment to detect patients’ clinical deterioration is less than 30% effective [8]. This underscores the importance of effective tracking of outcomes data in the psychedelic medicine space.

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• Measurement-based care (MBC) is crucial in tracking the long-term effects of these therapies and understanding how patients fare between treatments.

• MBC helps to legitimize psychedelic medicine in the eyes of the public, healthcare leaders, insurance companies, and regulatory bodies like the FDA.

• Beyond robust clinical trials, clinics should implement MBC in “real-world” practice to fully realize the potential of psychedelic medicine. It’s important to use an evidence-based, data-driven clinical approach in order to guard against stigma and skepticism from healthcare leaders, insurance companies, and regulatory bodies.

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Many community practices already use MBC, but it's not enough.

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Studies show that less than 20% of mental health providers utilize MBC in their practice [41, 42, 54].

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Instead, patient progress is typically measured by clinical judgment during in-person visits (which is often anywhere between once a month, to once a year). It's clear that using MBC in mental health care is a low-hanging fruit that hasn't been picked.

thus improving outcomes—without requiring

Some providers might not use MBC because MBC could add to their already-busy workflow, requiring not only more time but also burdensome paperwork.

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The Osmind Care Platform takes care of any concerns and makes MBC possible—and thus improves outcomes—without requiring any additional work from providers.

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The Osmind Care Platform consists of a mobile app for patients and provider portal for clinicians. Osmind automates every step of MBC including:

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• Data collection
• Patient-reported outcome
• AI-driven scoring and interpretation of validated questionnaires

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Summary and Conclusion

Measurement-based care (MBC) is revolutionizing the way psychiatrists and other mental health professionals practice. By monitoring and evaluating symptoms, response to treatment, illness severity, and suicide risk—all in real time—clinicians can make better treatment decisions with confidence.

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However, busy workflows have historically made monitoring challenging: cumbersome paperwork and administrative demands can take time away from direct patient care. Fortunately, with Osmind, it's now easier than ever to implement successful MBC in clinical practice without compromising your workflow.

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The future looks bright for measurement-based care—especially as biomarkers and wearable technologies for behavioral health eventually reach the mainstream.

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