Healing A Broken Mental Health System: Dr Sharief Taraman Of Cognoa On 5 Things That Can Be Done To Fix Our Broken Mental Health System

An Interview With Stephanie Greer

We must continue to expand and incorporate mental health training into primary care medical training. The specialist workforce shortage is worsening and even if we address the factors that are resulting in the supply vs. demand mismatch, it will take years to see improvement. However, we can expand the pool of clinicians qualified beyond specialists to assess and treat mental health conditions. For many people, this will help accelerate the path to diagnosis.

The current state of the mental health system is a conversation that echoes in the halls of policy-making, the corners of social advocacy, and within the private struggles of individuals and families. As we continue to witness an unprecedented need for robust mental health support, the shortcomings of the existing system become more glaring. It is within this backdrop that we seek the insight of those who are at the forefront of behavioral health. In this interview series, we are talking to behavioral health leaders, policymakers, mental health practitioners, advocates, and reformers to share their perspectives on healing our broken mental health system. As a part of this interview series, we had the pleasure of interviewing Dr. Sharief Taraman, CEO of Cognoa.

Dr. Sharief Taraman is Chief Executive Officer of Cognoa, a leading child health company developing AI innovations that enable life-changing early, equitable diagnosis and care for children with developmental and behavioral health conditions. He is dual board certified in neurology with special qualifications in child neurology from the American Board of Psychiatry and Neurology and Clinical Informatics from the American Board of Preventive Medicine. He served as Division Chief of Pediatric Neurology and Medical Informaticist at Children’s Health of Orange County (CHOC), where he continues to practice as an attending physician. Dr. Taraman brings nearly two decades of clinical specialization in neurodevelopmental conditions, clinical informatics, and healthcare innovation.

Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?

My parents immigrated to the US with less than $50 in their pocket to obtain doctorate degrees in Engineering. Being raised by engineers really helped me adopt a “problem-solving mindset” during my formative years. Exposure to their work process has allowed me to consider systematic changes to effectively serve the healthcare community — understanding a problem and designing the solution around it.

When I was 16, I started my own computer IT support business and an executive at Ford was one of my customers. She was impressed I was able to fix her computer and offered me an internship in the computer science department at Ford Motor Company. I then spent time in the quality & safety department creating a database and a web interface for Ford employees internationally to efficiently analyze crash safety data for all Ford vehicles.

I think I’ve always been attuned to understanding problems and leveraging data to inform how to make good decisions.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Do the right thing without worrying about the consequences. External validation has never been a motivating factor for me. If there’s a problem and I have the skillset to help, I always will, because it’s the right thing to do.

Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective what is “broken” today?

I think everything’s broken, right down to the way society thinks about mental and behavioral health. We’ve stigmatized it for years and have therefore failed to understand it.

Truthfully, everyone should have mental health preventative care, just like we make it a point to have physical health preventative care. We should manage our mental health the same way we manage our physical health.

But it is much harder to measure mental, developmental, and behavioral health than it is to measure physical health. There’s an alarming shortage of specialists who are qualified and/or trained to meet the growing demand for care, and even fewer tools to assist them. This cannot continue. Mental health care cannot and should not be confined to specialist care — primary care physicians, such as family doctors and pediatricians, need to participate in mental health evaluation, management, and treatment. For them to do so, it is vital that we equip them with technology to do so. This is what we at Cognoa are working hard to ensure. By harnessing AI and population representative data, we can better equip both primary and specialty care physicians to provide accurate, accessible evaluation and diagnosis to activate care as soon as possible.

It’s also important for people to understand that you don’t have to be struggling with depression or anxiety to check in with mental health clinicians to assess stress management skills and the like regularly. But the stigma surrounding mental health causes society to feel like it’s not part of regular healthcare. And this is such a small fraction of what is broken in healthcare. We desperately need to examine the system in its entirety — from medical training to administrative work and insurance roadblocks — and so much more.

What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?

There are really great, passionate people in mental and behavioral healthcare. It’s exciting that we’ve started to see a rise in acceptance of digital devices and solutions in the space. These solutions require extensive amounts of data. By responsibly harnessing this data — capturing and drawing on large, population representative datasets — AI algorithms can be trained to quantify a person’s developmental, behavioral, and/or mental picture at any given moment in time. These technologies also allow us (physicians, researchers, and healthcare technologists) to collect other important data, such as physiologic monitoring, which is helping us to better understand mental health conditions and start identifying issues earlier. Mental healthcare has been largely subjective to this point, relying on specially trained clinicians, of whom there are so few, so the rise in acceptance of these data-driven solutions is a great step in the right direction.

I think we’re also beginning to see important changes implemented within medical education to widen the pool of healthcare professionals who can help patients with their mental health needs. The healthcare community realizes that it’s no longer tenable to depend solely on specialists to screen for and manage health conditions — nurses, allied health professionals, and primary care doctors are incorporating mental health into general care.

We are also seeing a new generation of trainees and early career healthcare professionals that were exposed to a curriculum that educated them on mental health and how to use new technologies, like artificial intelligence, and data to support them to help patients. That generation is now finishing residency and are about to start practicing. That gives me hope.

In your opinion, what are the 5 most impactful things that could help heal the broken mental health system? These could be on any level including training, workforce, policy, culture, equity etc.

1. The industry, and society as a whole, must prioritize mental and behavioral health with as much emphasis given to physical health. It cannot be delineated, and we must help people understand that psychiatric and psychological conditions have a neurobiological basis.

2. We must continue to expand and incorporate mental health training into primary care medical training. The specialist workforce shortage is worsening and even if we address the factors that are resulting in the supply vs. demand mismatch, it will take years to see improvement. However, we can expand the pool of clinicians qualified beyond specialists to assess and treat mental health conditions. For many people, this will help accelerate the path to diagnosis.

3. We must focus more heavily on pediatrics. If there is one point that I want to be sure to emphasize, it’s that early is everything. People will miss out on long-term, meaningful mental health outcomes by waiting to address mental health until adolescence or adulthood. Teach children coping mechanisms and strategies from a young age. The vast majority of mental health conditions start in childhood and peak in adolescence. We need to focus on pediatric mental health to ultimately make a difference for adults. For example, children diagnosed with autism late are at a much higher risk of depression, anxiety, and suicidality than those who benefited from therapies when they were 2–3 years old.

4. The healthcare system needs to invest in and embrace technologies to increase accessibility to care and optimize clinical and administrative efficiency. That being said, technology being used in the healthcare space must be built on representative, actionable datasets in order to properly serve all patients, regardless of race/ethnicity, gender, or socioeconomic status.

5. Technologists, policymakers, and healthcare professionals must work together to clearly and intentionally address the biases, inequities, and injustices plaguing the system.

If all of the items on your list were magically implemented tomorrow what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?

We’ll know when the system is healing when children are no longer stuck on waitlists to get help and every person has easy accessibility to care. But mostly, we’ll know the system is healing when the average age of diagnosis — of kids including all demographics and backgrounds — decreases and the prevalence of mental health conditions start to decrease.

What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?

Along with my colleagues at CHOC, we have mentored nearly 1,000 high school and college students over the last decade as part of the Sharon Disney Lund Medical Intelligence, Information, Investigation, and Innovation Institute Summer Internship Program. Many of the students have experienced chronic health conditions and are the first generation in their family to go to college.

During the internship, we mentored these students to replicate the things we do well. One of those things is understanding the systematic dysfunction within healthcare. More importantly, the students gain an understanding as to why it’s so important to go into healthcare putting the patient first. We discuss how to leverage research and data science to change the status quo. It’s inspiring to hear their ideas for the future and gives me hope for the next generation of physicians.

How do you see technology shaping the future of mental health care and its accessibility?

All clinicians can agree major change is necessary, especially for our children. Earlier diagnosis is a necessary path to providing children with better life-long mental and behavioral health outcomes.

Empowering primary care providers with reliable, unbiased, digital solutions to diagnose and intervene earlier, in-person or virtually, will positively impact the trajectory of children’s lives and relieve years of pressure placed on the health system.

In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?

These social determinants of health are known to both increase risk for worse health outcomes. There’s a vicious cycle, for example the zip code you live in may limit access to healthy food and spaces to exercise resulting in poor physical and mental health. That zip code may also lack specialists, for example 80% of counties in the United States lack an autism diagnostic center.

Health literacy and cultural factors can also play a significant role. One project I am working on in collaboration with the American Academy of Pediatrics — Orange County chapter and one of my mentees is a storybook that teaches the importance of well child visits and developmental monitoring. We have an obligation to help parents and caregivers to get help for their children earlier because early intervention will directly impact their mental health for the rest of their lives.

In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?

Early intervention is absolutely critical. Mental health issues in many ways function similarly to other neurological disorders in that the longer and more frequently something happens the more hard wired it becomes. For example, seizures left untreated generally become more intense, more frequent, and more difficult to control with medication. Similarly, depressive and persistent negative thoughts become more entrenched with research showing that neuronal structural changes are correlated to risk for suicidality. In developmental behavioral health, for example, where early interventions for disorders like autism are vital to ensuring optimal life-long outcomes for patients and their families, an overhaul of the current policies and processes, wherein pediatricians must refer children to specialists for diagnosis, is critically needed.

Policies like these are outdated and further exacerbate the issue, forcing children and their families to wait months or even years to see a specialist, delaying their access to care during the critical neurodevelopmental window where interventions have the most life-changing impact. The same can be said to support mental health needs. We must treat childhood and adolescent mental health with the same urgency we treat physical health. Increasing early accessibility and eliminating disparities are absolutely paramount.

We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. :-)

Ha. Well, there’s one person in the world I always look forward to having breakfast, lunch, or dinner with: Cognoa’s founder, Dr. Dennis Wall. When we are working together we are always coming up with creative new ways to make the world better. I am always happy to meet with people who want to do the right thing and productively work with us to fundamentally change healthcare — starting with kids.

How can our readers further follow your work online?

Readers can visit our website at https://cognoa.com/ and follow us on LinkedIn https://www.linkedin.com/company/cognoa/ .

Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.

About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.