Over the last decade, digital mental health has come into the spotlight, raising large amounts of venture backing, gaining interest from policymakers and seeing wider adoption. However, unclear efficacy standards, poor engagement and user trust have been obstacles that the community has often faced, according to panelists at WISH 2020 this morning.
“I’ll start by just saying that one of the main issues we had to deal with in thinking about what needed to happen in mental health care in both developing and in developed countries, was to address the problem of engagement,” Dr. Tom Insel, cofounder and chair of Humanest Care, said at WISH.
“We know that mental illness is very, very common – we think about one in five people being affected, and one in 20 really being disabled by serious mental illness. These are serious medical problems, and yet, unlike so many areas of medicine, a big barrier to progress has simply been getting people into care.”
The COVID-19 pandemic has helped to advance the technology. Digital tools have seen an uptick during the crisis. Meanwhile, there has also been an increased need for mental health care.
“One of the things that’s happened in 2020 is COVID-19, and this has brought into a higher profile the need to get services, and technology-based services, to people,” Helen Christensen, director and chief scientist at the Black Dog Institute, said during the panel.
“We know that 75% of some populations are experiencing psychological distress. Many people are developing mental illness for the first time. And how are we going to deal with the scale of this problem? ... [W]e can deliver digital therapies through the Internet to people.”
In addition to the panel discussion, Christensen and Insel, along with other researchers, worked on a new WISH report called The Digital Mental Health Revolution: Transforming Care Through Innovation and Scale-up, which broke down the issues that the technology faces, as well as the opportunities.
“There are now more than 10,000 mental health apps available, and almost 100 new digital mental health start-ups every year. Some of these tools have proven effectiveness, are low cost, and are already benefiting millions of people around the world – for example, instant crisis text messaging, digitized or ‘gamified’ versions of cognitive behavioral therapy (CBT), and online training packages for frontline staff,” the report reads.
“However, many other tools have underperformed, meaning the gap in ‘effective coverage’ for mental health disorders still remains, with as few as one in 10 people in need benefiting from traditional mental health services – even in well-resourced health systems.”
The report goes on to note that many of the heavily researched tools face low consumer adoption, whereas commercially driven innovations have less data to back them up, but often see higher rates of engagement.
Writers of the report urge stakeholders to keep in mind four attributes: “Move apps to an integrated ‘operating system’ of care, focusing on developing both effective and engaging tools, addressing inequalities and building trust in tools."
During the panel discussion, speakers discussed this engagement piece, and noted that the bulk of the apps on the market are targeted towards North American and European audiences. However, this can create a barrier to adoption for people from other parts of the world.
“You need to communicate to the target group. Usually what we see now is the technologies available out there are targeted towards the Western society, towards society that comes at mental health from a different perspective than other parts of the world,” Dr. Dena Al-Thani, assistant professor and the director of interdisciplinary programs at Hamad Bin Khalifa University, said during the panel.
“Therefore, we need to include all groups, and by groups I mean specific nationalities, specific ethnicities, specific disabilities and the different age groups that we look at when tackling mental health problems.”
Another global barrier is access to infrastructure, which can prevent patients from being able to access online resources.
“You need to involve community developers and tech developers. For lower- and middle-income countries [where] there maybe access issues – access to the Internet, access to data,” Chinwendu Ukachukwu, pharmacist and mental health advocate, said during the panel discussion.
While each country has its own unique challenges, panelists said it is important to share different ideas. Ukachukwu said that wealthy countries could look to low- and middle-income countries to learn about community programs and, in particular, digital community programs. She noted that in many of these countries there are opportunities for what she calls a “digital friendship bench” where individuals can connect, thus preventing loneliness.
Another global effort on the horizon is making measures for these tools and their efficacy.
“We are trying to get policymakers, and researchers and clinicians, to all use some core measures … so we have a common language to help us understand what it means globally,” Miranda Wolpert, head of mental health priority area at the Wellcome Trust, said during the panel.
While there is no one solutions to all of the world mental health gaps, Christensen said that taking a blended approach to care could be one path in the future.
“Digital is a way for people to connect. The digital friendship bench is what happens in forums for people to support each other,” Christensen said.
“I think that for some mental health problems we need the combination of clinicians, content and help. Not even clinicians, but that knowledge that is effective for changing people’s thoughts and behaviors so that they improve. I think this mixture between community and the knowledge that has been acquired by clinicians over a long time, that can be shared digitally, is really the ultimate way to do it.”