Mental Health Medical Tourism: Opportunities for investors

Mental health medical tourism opens opportunities for affordable, high-quality diagnosis, treatment, and rehabilitation for the most devastating conditions.

Medical tourism for mental health opens a wide breadth and depth of developer opportunity with the diagnosis, treatment and rehabilitation services for a vast array of mental illness, including:

• Depression & Mood Disorders
• Eating Disorders
• Anxiety Disorders
• Obsessive Compulsive Disorder
• Addictive Disorders
• Complex Co-morbidity

Private Centers of Excellence have been established in locations throughout Europe, the Caribbean, North America but there is room for additional development on all 5 continents where medical tourism destinations are being organized.

Mental Health Medical Tourism Requires Less Startup Capital

The medical tourism investment in mental health diagnosis, treatment and rehabilitation is generally not as expensive as developing a full service hospital or even that of an ambulatory surgery center. Often, a remote property can be obtained on a purchase or long term lease for vertical development.

I interviewed Maria K. Todd, an international strategy expert in medical tourism development and the CEO of Mercury Advisory Group,  in Denver Colorado. She shared this with me: “Lately, we’ve been hired to evaluate many of these remote properties on behalf of investors considering medical tourism development opportunities. We’ve examined bare ground, half-finished or run-down waterfront hotels, rural hillside properties, abandoned thermal springs resorts in Greece, and even parts of the 2004 Olympic Village site in Athens. Almost all of these have been public-private partnership (PPP) deals sponsored by national or regional economic development projects. Each has a potential investment strategy that could be very promising in the right setting, with the right investor, strong support from the community and talent in the management of the project.”

Todd says that what governments seek when they offer these PPP programs is results. These results come in the form of:

• tax receipts from new business, tourism receipts and satellite spend from visitors and locals, alike
• education and training opportunities for local citizens in the community who will work at the project
• attracting foreign arrivals for long-stay visitors and their companion travelers (most family-oriented, destination mental health treatment programs tend to run 28+ days or longer)
• private care outlets for local citizens who might otherwise elect to travel for mental health medical tourism care

Investors, on the other hand seek handsome return on investment, lower risks capital investment requirements, and quick starts to get a project commissioned and into full-service operations. Mental health medical tourism offers all of these objectives, and can be situated on the site of an abandoned or faltering hotel property proximate to surrounding land, often available to be acquired at bargain prices.

Mental health projects tend to focus on one or more of the following conditions

Mood Disorders / BiPolar and Depression

• Latest advancements and protocols as well as proven techniques for most conditions few of which require expensive technology
• Integrated care teams specializing in adolescents and adults collaborating at one location
• Treatment offers can include a combination of
  • Cognitive Behavioral Therapy (CBT) (based on the theory that much of how we feel is determined by what we think)
  • Dialectical Behavior Therapy (DBT) (a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment)
  • Insight Oriented Therapy (IOT) ( a form of treatment that helps people through understanding and expressing feelings, motivations, beliefs, fears and desires)
  • Family therapy, and
  • Calibrated medication therapy for positive long-term outcomes.

• State-of-the-art facilities that can offer key modalities proven to resolve treatment resistant mood disorders, including:
  • Transcranial Magnetic Stimulation (TMS) Therapy – a safe, proven, FDA-approved treatment for depression, rarely covered by insurance, and requires MRI equipment and a lead-lined structure or room to operate the equipment. MRIs can be purchased used
  • Industry standard Electroconvulsive Therapy (ECT) – a proven, low-risk technique. The ECT procedures done in the treatment room does not include charges for anesthesia, drugs, or supplies required for this procedure because these items vary for each patient. Fees for physician services or anesthesia administration are also not usually included, and are billed separately by the physicians involved.

So, in summary, the treatments here are medication, talking, and if treatment modalities are offered, some technologies of varying capital expense are required. Rooms in a mental health setting tend to be sparse for therapeutic and safety reasons. Patients are often expected to make up their own beds and serve themselves at meal times. This further reduces staffing costs for housekeeping and maid services, and wait staff in food and beverage outlets. In some mental health facilities, family members or companion travelers are housed in one hotel structure adjacent but separated from the treatment area, while the patient is housed in a separate, secure facility.

In the USA, residential private room costs can range from $1850 – $2250 and upgraded suites can raise the daily rate by as much as $150-$300 per day. Treatment programs tend to run 21-, 28- and 45-days in duration. Additional services, such as ECT add additional revenues in the range of $1000-$1250 per session.

TMS can average $600.00 (per unit), more or less, and Psychological Testing (electronic or paper-based) $100 – $200.00 including the interpretation. The initial course of treatment typically consists of 5 TMS treatments per week over a 4-6 week period, for an average of 20-30 total treatments. Each treatment session lasts approximately 37-40 minutes.  During treatment, the patient is wide awake in a comfortable chair.  A small, curved device, about the size of a cupped hand, rests lightly on the patient’s head, delivering focused magnetic stimulation directly to the area of the brain thought to be involved in regulating mood.  The magnetic field impulses of the device are the same strength as those used in magnetic resonance imaging (MRI) machines. In a well-operated clinic, each TMS unit can generate about 12-18 treatment sessions per day. About 28% of the population suffering from Major Depressive Disorders (MDDs) are not adequately treated by medication and talk therapies and can benefit from TMS treatments.

TMS Therapy is:

• Safe, with over 20 years of research behind it;
• Proven — in open-label clinical trials, 1 in 2 patients suffering from depression reported significant improvement; 1 in 3 patients were completely free of depression symptoms after six weeks of treatment;
• Targeted, stimulating only the part of the brain thought to be involved in regulating mood;
• Easy on the body, with no medication required and none of the systemic side effects commonly associated with antidepressants — the most common side effect of TMS is a generally mild to moderate scalp discomfort.

The most common side effect is pain or discomfort at or near the treatment site.  There is a rare risk of seizure associated with the use of NeuroStar TMS (0.1% per patient). Because of this risk, the treatment is conducted in the presence of qualified medical personnel with the capacity to respond immediately if a seizure arises.

Eating Disorders

Eating disorders include a variety of serious psychosomatic conditions. The most common types of eating disorders are bulimia nervosa, anorexia nervosa and binge-eating. Patients become so obsessed with what they eat and how closely they can control their weight that it interferes with their normal life activities. If left unchecked, deterioration can lead to life-threatening problems. Young females are the most endangered social group. In medical tourism, these patients often travel with a parent, thus accommodation is required for two, in separate quarters.  The pressures of certain professions also sometimes predispose patients to eating disorders, including, but not limited to models, sportspeople,  and entertainers.

Eating disorders, beyond the psychological anomalies (depression, antisocial behavior, suicidal intentions) can lead to a variety of severe complications such as:

• tooth decay
• kidney damage
• heart problems and abnormal blood pressure
• bone weakening
• anemia
• irregular menstrual cycle

Similar to Major Depressive Disorder treatments, eating disorder treatment centers don’t require nearly as much capital to open and operate as other healthcare facilities.

• Eating disorder treatment targets both the physical and psychological condition including medication, nutrition control and psychotherapy
• Medications are used to relieve compulsive, uncontrolled behaviors
• Behavioral and cognitive therapies (talk-based) are designed to help patients acquire healthy eating habits and set up a daily eating routine in order to gain or lose weight depending on the eating disorder.
• In case of medical problems that require monitoring of blood chemistry and other levels, a contract laboratory service that offers pickup and stat lab results is a way to avoid commissioning a full-service laboratory on the premises.

Eating disorder recovery is often a lengthy procedure. Behavioral Health In-Patient Facilities treat medically complicated cases. They are equipped to medically stabilize and treat the most severe eating disorder cases. Inpatient facilities can accommodate those that are too medically compromised to be accepted into traditional inpatient eating disorder treatment facilities. Patients then progress to partial hospitalization programs (PHPs) and then on to outpatient programs.

According to Maria Todd, “one way that this program can work is with a central treatment campus partnered with a small, boutique-style, full-service private hospital or clinic and nearby service apartments or a hotel adjacent that has two separate buildings or towers on a sprawling rural campus.”

She explained that rural campus orientation works well where there could be a risk of elopement or risk of local contraband being brought onto the campus. She continued “Rural settings are generally less expensive to develop, land is less expensive, and more open space accommodates year-round outdoor activities in the fresh air and sunshine in warmer climates.

Occupational therapy activities such as gardening, talk therapy sessions out by the pool, animal care, and opportunities for healthful exercise are all easy options. Two separate buildings enables the program to offer separate accommodation for travel companions but makes it convenient for them to participate in family therapy activities when scheduled.”

 Anxiety treatment

Anxiety disorders can be categorized into different themes including panic disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder, social anxiety disorder, specific phobias, and generalized anxiety disorder (GAD). Each anxiety disorder has a different set of symptoms associated with it, however, all anxiety disorder symptoms have the shared experience of excessive, irrational fear and/or dread.

Anxiety disorders can often occur alongside other mental or physical illnesses, such as alcohol or substance abuse, depression, or a medical condition, which may mask anxiety symptoms or possibly exacerbate them. Further, because of the high levels of stress that accompany anxiety disorders, many people experience significant physical symptoms (breathing trouble, GI problems, headaches, blood pressure abnormalities, etc.) which can require medical treatment as well. Anxiety disorders are a mental illness and as such require treatment in order to learn effective coping strategies so as to minimize disruption to daily living.

Similar to the other two disciplines above, most of the activities and therapies are talk-based, but the psychosomatic symptoms that can accompany anxiety disorders, cardiac symptoms in particular pair well when the residential treatment facility is within 5km of a full-service, boutique hospital or clinic with a cardiologist and certain diagnostic screening technology equipment on hand. According to Maria Todd, the program can launch with a partner, but the best strategy is often to bring all services in under the control of the medical tourism brand.

Comprehensive treatment programs include intensive psychotherapy, self care skills, household management and medication management, nutrition and physical well-being programs.