What’s next for digital mental health companies?

DDigital mental health startups can look like big tech companies: consider the $5.1 billion in venture capital investment in 2021, but does its economic value match its impact and clinical value?

It’s an awkward question with a short answer: it’s too early to tell.

There is no question that the most successful companies are disrupting the delivery of mental health care by offering access and convenience. And why not? Unlike procedure-based medical or surgical specialties, most mental health care involves evaluation through an interview and treatment with medication and psychotherapy. Every part of this can be done remotely, with faster response times and greater convenience than is available in traditional in-office practices.

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It is not surprising, then, that a start-up like Cerebral (disclosure: I am a scientific adviser to this company), which launched with remote drugs and therapies less than two years ago, is now one of the largest mental health care providers in the nation.

But digital mental health is still in its first chapter: moving the same care from the office to the Internet to improve access and convenience. If digital mental health truly transforms care, its next chapter must focus on improving outcomes. How will that happen? Here are some insights that have come from the six years I spent straddling the worlds of technology and mental health care.

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I see three issues that need to be addressed to improve mental health outcomes. Each of them can be solved (in part) as technology disrupts the traditional mental health care system, but not through another app or another algorithm. Ironically, the solutions stem as much from the culture of the tech industry as from its products.

The first problem is commitment, or the lack of it. The people most in need of mental health treatment tend to be the least likely to seek it. Nearly two-thirds of the people who die by suicide and more than half of the young people who do suicide attempts have not been receiving mental health care. Any visitor to a public or private mental health facility finds little attention paid to the patient’s journey and even less concern for the needs of families.

Tech companies know how to create engagement, possibly all too well. As digital mental health companies disrupt traditional mental health care, they can use the proven potential of technology to reach and engage people by understanding user experiences and creating products to (and with) them, not just for payers or providers.

The second problem is the quality of care. As with any other aspect of medicine, improved quality will require training providers in evidence-based care, measuring treatment outcomes, and improving practice based on this feedback, none of which has been standard in care. traditional mental health.

Although the technology can be used to scale training With a pace and depth never before possible, measurement and feedback may be the most important innovations for digital mental health. Tech companies may actually be too good at collecting data and using the feedback to iteratively improve performance. A part of this culture could go a long way toward improving a field that lacks any biomarkers and has yet to adopt objective measures of mood, cognition, or behavior. I believe that natural language processing and digital phenotyping can transform teletherapy 1.0 into a real-time measurement-based care system to create teletherapy 2.0.

The third problem is accountability. In the world of therapy, the financial incentives for the provider are prolong treatment, not complete it. I have yet to see any public mental health clinic or private psychiatric hospital hold their providers accountable to anything like a set of key goals and outcomes.

Digital mental health companies should incentivize results rather than keep people in therapy. Value-based pay, which will depend on the ability to better measure outcomes, remains an aspiration in mental health. The culture of technology companies can also point the way to solutions. These companies, of course, focus on being accountable to their boards and shareholders. But their execution strategies are defined by objectives and key results or some similar detailed plan for internal accountability.

In the last five years, digital mental health companies have begun the transition from a dysfunctional delivery system that ignores consumers, neglects quality, and avoids accountability to a better model. Academic articles on technology and mental health often point to small effect sizes wave lack of regulation. These articles remind us to manage expectations and guard against misuse, important considerations in the first chapter of the digital mental health playbook.

The biggest problem is that the traditional mental health care system has failed patients and their families for far too long. The next iteration of digital mental health may use innovative approaches to engagement, quality, and accountability from the tech industry to create mental health care that improves outcomes.

Thomas R. Insel is a psychiatrist and neuroscientist; co-founder of MindSite News, Mindstrong Health, and Humanest Care; former director of the National Institute of Mental Health and author of “Healing: Our Journey from Mental Illness to Mental Health” (Penguin Press, February 2022). He is an advisor or board member of Alto Neuroscience, Cerebral, Compass Pathways PLC, Embodied, Healthcare Capital, Koa Health, NeuraWell Therapeutics, Owl Insights, Psych Hub, Uplift Health, and Valera Health, as well as several nonprofit foundations. .