An estimated 1 in 4 people globally have a diagnosable mental health disorder at any given time according to the CDC. These rates are even higher when it comes to populations affected by other chronic conditions such as diabetes and cardiovascular disease - conditions which are now booming thanks to the modern afflictions of overly processed diets and sedentary lifestyles. Unfortunately, essential access to care and support for those living with mental health disorders has eluded a large proportion of those in need of intervention globally. Continuing on this track is simply not an option. How can we leverage digital tools to alleviate some of this burden and support improved mental health?
Mental health has been kept in the dark for all too long due to high access barriers of cost and stigma in addition to pharma companies struggling to produce effective therapies. Now there is a growing body of empirical evidence that poor mental health can both cause other conditions to appear, and conversely that many conditions can trigger poor mental health. Research at the junction of inflammation, cognitive function and various diseases has also further reinforced the need for healthcare stakeholders and consumers to zero-in on their mental health. In addition to this bi-directional relationship, the penny is dropping that providing alternative or supplementary services for those living with mental health disorders may in fact be an economically sound move e.g. reducing the amount of sick days people need to take from work, faster recovery times, reduced readmission's.
While some finer details in the evidence are still being explored and debated, it is clear that we need an explicit focus on re-framing how we think about and address mental health and at present it seems digital will help us get to that point with tools such as telepsychiatry, meditation and mindfulness apps, mental health support chatbots and remotely delivered Cognitive Behavioural Therapy. What is most exciting is that these solutions are no longer being confined to the treatment of diagnosed mental health disorders but coming to be seen as a core element within a more holistic approach to healthcare.
The health tech investors have been keeping up to date on the zeitgeist and the surge of evidence in the mental health space and placing their own bets on digital mental health offerings. In January 2020 Octopus Ventures estimated a five fold increase in digital mental health solutions investment in the past 6 years bringing us to £580 million in 2019 with total deal count also tripling in the same time frame.
So, how far have we come on this digitally supported mental health journey and where to next? Read on to find out.
Understanding the digital health landscape of mental health solutions
It’s clear that digital mental health solutions are gaining momentum in addressing core areas of human health and disease both from a user traction perspective, but also in terms of evidence generation and investment. However, there are important distinctions that need to be made to allow the community to fully grasp and enable the opportunity at hand. Both the solutions on offer and the conditions they aim to diagnose, manage and treat are highly heterogeneous.
Digital biomarker and digital phenotyping solutions for mental health disorders, for example, are comparatively at a more nascent stage of scale and evidence generation. Teams such as the Harvard Chan School of Public Health Research Platform Group, led by JP Onnela, are exploring how we can use data generated from the use of mobile devices (and other in-situ devices) to understand the digital phenotype of mental health disorders. Despite these solutions showing early promise in understanding new dimensions of human health and disease they have not yet scaled in practice.
At the other end of the spectrum telepsychiatry services are starting to gain momentum with an estimated market size of 6+ million by 2025. Telemedicine giant American Well acquired Aligned Telehealth in November 2019 to bolster its behavioral health and telepsychiatry capabilities reportedly making them the largest offering of this type in the US. A JAMA review of telemedicine service growth in commercially insured populations in the US found that 53% of telemedicine consultations identified were tele mental health interactions.
Beyond telepsychiatry offerings, which are often scaled in partnership with health systems and health plans, there is a wash of direct to consumer (D2C) mental health solutions working to empower consumers to prevent and manage their mental health independently. Previously disregarded as pseudoscience, meditation and mindfulness based apps are coming to the fore as being very viable options for mental health concerns and chronic condition comorbidities. Headspace, realising the distinct shift in public perception launched a subsidiary, Headspace Health, with the mission of integrating their digitised meditation guides into clinical practices and creating prescription meditation apps - for patients and clinicians alike.
These varied approaches have produced variable clinical evidence and attracted diverse partnerships, both of which will ultimately be essential to ensure they make a lasting positive impact.
Section two - The Evidence Behind Digital Mental Health Tools
A Beth Israel Department of Psychiatry study in Nature last year found that a majority of the apps studied do not provide evidence or peer-reviewed studies to back up their products. While there are numerous solutions on offer that disregard the need for robust scientific validation, there are others who are built on a foundation of clinical research and replicable methods that aim to give their users and potential partners confidence in their interventions. Here are just a few.
- CBT - Silvercloud Health A randomized controlled trial of an internet-delivered treatment: Its potential as a low-intensity community intervention for adults with symptoms of depression.
- Findings: Demonstrated the efficacy of the Silvercloud Space from Depression treatment. Test group participants (N = 96) demonstrated reliable and statistically significant changes in symptoms from pre-to post-intervention
- Meditation & Mindfulness - Headspace A Pilot Mobile-Based Mindfulness Intervention for Cancer Patients and Their Informal Caregivers
- Findings: Patients and caregivers (N = 42) both experienced statistically significant reductions in distress levels and anxiety in addition to improved sleep scores
- Mental Health Chatbot - Woebot: Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial
- Findings: Unblinded trial in collaboration with Stanford of 70 individuals aged 18-28 years determined that conversational agents appeared to be a feasible, engaging, and effective way to deliver CBT.
When we reviewed digital health evidence generation and publications last year mental health and substance use disorder focused digital interventions appeared as some of the most heavily researched areas. The research to date has both highlighted the merits and demerits of some of the digital mental health offerings on the market however there remains a need to further examine the most appropriate treatment combinations for different conditions and comorbidities.
Emerging Digital Health Partnerships
Digital mental health companies are attracting interest from partners including national health systems looking to address public health needs, employers looking to support the productivity and resilience of their employees, insurers interested in reducing unnecessary costs. We still have some way to go before we see these solutions offered as mainstream and viewed but for now we have a number of beacons to guide the way.
From a health system perspective the NHS has made some impressive strides to enable their clinicians to prescribe the mental health tools they see as most appropriate. The NHS have been providing access to digitally enabled CBT via partnerships with Ieso and Silvercloud for a number of years in addition to investing and partnering for digital health enabling infrastructure which signals the NHS commitment to leveraging the potential of digital for mental health and other underaddressed areas.
From a pharma perspective we have also seen a number of partnerships in the mental health space despite being traditionally regarded as sitting outside of the life sciences wheelhouse. Most recently Happify and Sanofi announced a partnership to gain regulatory approval for their meditation and mindfulness application to be built specifically for MS patients. As with any digital health efforts, partnerships and collaboration will be key to addressing mental health at scale.
A Closing Thought
It is important to remain cognisant of the fact that many of the mental health disorders we are seeing, particularly in high income contexts, today have been strongly associated by the isolation of connecting predominantly via mobile devices or other devices rather than maintaining strong community ties and deep connections. Digital health solutions will by no means replace this need for in person connections and only addresses one part of the puzzle in the social determinants of health realisation.
However, when it comes to those who are on long waiting lists to see a psychologist, psychiatrist or counsellor, or those who find themselves in a situation when stigma is associated with seeking mental health guidance and support or simply those who realise the importance of exercising their mental health as they would their bodies, digital mental health solutions supported by robust evidence.
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