How digital products are improving mental healthcare.

The global mental health crisis was intensified by COVID-19. The shortage of practitioners, long wait times, and high costs are only a few of the factors contributing to the gap between those who need care and those who have access to it. The World Health Organization reported a 13 percent increase in mental health conditions and substance use disorders over the last decade. Depression and anxiety alone cost the global economy around $1 trillion per year, with depression being one of the leading causes of disability. The total cost of mental healthcare for the global economy is projected to rise to $6 trillion by 2030. However, the global median of government health budgets that go towards mental healthcare and support remains below 2 percent.

How can we possibly keep up? Since the start of the pandemic, there has been a significant increase in demand for counseling services to treat cases of anxiety and depression. A survey conducted by the American Psychological Association found that psychologists are facing bigger workloads, with 68 percent reporting growing waitlists. Experts predict that within a few years the United States will be short between around 14,000 and 31,000 psychiatrists, with other mental health professionals being increasingly overextended as well.

In addition to the shortage of professionals, there are also barriers related to cost and stigma that have existed long before the pandemic. Privatized care on average can range from $100 to $225 per hour and the stigma around mental illness can prevent people from seeking treatment.

Enter digital enabled mental healthcare.

It’s no coincidence then that the volume of mental wellness apps for iOS and Android have been steadily increasing, but are these apps effective?

There are pros and cons to technology-enabled health and wellness care. Only a fraction of what’s available is actually recommended by healthcare professionals, but when done well, mental wellness apps can help fill a growing gap in care and alleviate strain on traditional mental health services. Depending on your source of information, there are somewhere between 10,000 to 20,000 mental health apps available today, and the market continues to grow. Many are low cost relative to traditional services and are right at our fingertips.

Let’s examine three of the most common mental health app types:

1 – Mindfulness and meditation apps.

Our phones are often the biggest culprits in distracting us from mindfulness. However, there are also many mental wellness apps to educate on and enhance mindfulness practice. When practiced regularly, mindfulness and meditation provide a number of health benefits, including reduction of depressive symptoms, anxiety, and stress. Similar to exercise, these are activities that need to be done routinely to build up skill and see results. Mindfulness and meditation apps are a great entry point for people wanting to improve their mental wellness.

Headspace is one of the most popular options and offers science-backed meditation and mindfulness tools with the aim of improving the health and happiness of its users. The app launched in 2012, and achieved substantial organic growth with the outbreak of COVID-19. Since March 2020, Headspace has doubled its number of registered users, now with over 70 million members across 190 countries. Calm, arguably Headspace’s biggest competitor, also experienced significant growth in early 2020.

So, while there has been increased adoption of mindfulness and meditation apps, do they actually work? There are a number of peer-reviewed studies that suggest Headspace can reduce stress and help improve focus and happiness. The danger however, is in potentially misleading people into believing these apps can be used in place of more effective and needed care as they are not designed to treat medical conditions.

2 – Emotionally intelligent AI.

Cognitive Behavioral Therapy (CBT) is a type of psychological treatment that is widely used for a variety of mental health conditions and disorders. CBT is a structured way of helping people to identify, challenge, and change cognitive distortions that are causing them to experience difficult emotional or behavioral reactions.

Cognitive distortions are irrational ways of thinking and behaving, and when excessive, can cause distress or negatively impact one's quality of life. In worst cases, this can lead to maladaptive behaviors and increased risk for mental health disorders like depression.

While there are a number of Cognitive Behavioral Therapy apps that teach CBT skills to help treat anxiety, depression, and insomnia, what is even more interesting are the chatbots that have been modeled after therapeutic frameworks like CBT.

As machine learning and natural language processing continue to advance, it makes sense that a number of emotionally intelligent chatbots have surfaced. Developed in collaboration with psychologists and therapists, they are able to conversationally guide people through CBT practice and help them challenge distorted thinking. With immediate access and no judgment, a chatbot can serve as early stage mental health support and a helpful stepping-stone towards a human therapist.

A good example of mental health tech innovation is the Wysa AI coach. The FDA recently granted Wysa Breakthrough Device Designation following a peer-reviewed clinical trial that found their approach to online counseling comparable in effectiveness to in-person counseling. This FDA designation is intended to provide patients and health care providers with expedited access to medical devices by speeding up development, assessment, and review for market approval.

Wysa is not the only chatbot that has received favorable recognition. Other competitors such as Woebot and Youper have also demonstrated the ability to successfully reduce depression and anxiety symptoms in clinical trials. That said, most of these companies are explicit in acknowledging that they are meant as a way to improve mental health accessibility. Artificial Intelligence should be used to assist practitioners by filling gaps and improving care, not replace them.

3 – Human care apps.

While technology is enabling new ways of addressing our collective growing mental health needs, at some point an actual licensed medical provider may be needed. However, finding a practitioner through traditional means is easier said than done. There are a number of apps out there that aim to remedy this problem by matchmaking people with providers licensed to practice in their region - also known as telehealth for mental health. One example is Talkspace.

Based on an initial assessment, the Talkspace algorithm matches a patient with three different therapists and lets the patient choose which one they feel is best for them. While patients are able to schedule virtual sessions with their matched therapist, they can also simply communicate through text or voice messages. This offers flexibility for both the provider and the patient, and helps providers take on more patients than they might in a traditional setting. The downside is that responses from Talkspace therapists are sometimes considered short and surface-level, suggesting a lower quality of care.

Still, clinician-based virtual care can be a reasonable alternative to traditional face-to-face therapy because of the reduced cost and the scale of service it can provide by not being tied to physical locations. This ease of access comes at a cost though. Privacy concerns such as questionable handling of online therapy chat logs have been raised around many of the apps in this space. According to the FTC, counseling service BetterHelp pushed its users into handing over health information and broke its own privacy promises. According to The New York Times, Talkspace was caught promoting fake reviews, and former employees say the service doesn’t adequately respect client privacy.

As with most products and services, caveat emptor.

Pyramid of care.

Together, these three types of wellness apps can act as a pyramid of self-managed digital mental healthcare. The challenge lies in guiding people to the appropriate place for their needs. While there are many options that cater specifically to each individual layer, we will likely see more companies trying to create an ecosystem across all three.

Cautiously optimistic.

There is no doubt that digital mental healthcare can be effective and is a worthwhile alternative or supplement to traditional face-to-face care. It has the ability to reduce barriers to treatment and also aid in early detection and prevention of more serious conditions. The key is acknowledging that digital does not mean the absence of human intervention. Sometimes digital is being used purely for self-help, but sometimes it is being used to support professionals or foster connection between patients and professionals. The effectiveness of these solutions depends on the level of care the patient needs being appropriately matched with the level of care being provided.

As companies expand to offer more levels of digital care, it will become easier to triage people to the appropriate product and services for their specific needs. The mental healthcare system as it is today is incredibly disjointed and there is an opportunity to help create more streamlined and connected care.

That’s not to say that there is no risk. There are many valid concerns around the credibility of certain apps as well as their privacy. It will be increasingly important for people to do their research before engaging with some of these products. Individuals need to decide for themselves what their level of comfort is when it comes to exchanging their personal health information for more accessible treatment.

Having worked closely with several healthcare organizations to drive innovation through new products and services, we remain optimistic for the continued evolution in digital mental healthcare, and how this will continue to bring more support to those unable to use more traditional options. If your team is developing products and services in the health and wellness space and you’re seeking a partner to help elevate your offering, reach out to us to see how we can help.