At this week’s World Innovation Summit for Health in Doha, Qatar experts from around the world sat down to talk about the opportunities and challenges of employing digital health in the mental health field.
Globally more and more health professionals are stressing the importance of mental health services, but getting patients those services can be tricky. The shortage of trained professionals and the stigma of mental illness in many countries around the world have often created a barrier to treatment. But recently technology has come into play to tackle some of these challenges.
“There is a shocking gap in the world’s funding and the treatment of mental illness,” Lord Darzi, former UK health minister and chair of the World Innovation Summit for Health, said during his speech at WISH in Doha, Qatar on Tuesday. “In some health systems less than 5 percent of needs are met, while even in the most advanced countries just 20 percent get the care that they need. Ladies and gentlemen, there is no health without mental health.”
But the international mental health community is now turning to digital health as a way to overcome the major obstacles of resources and stigma in many countries.
“We don’t have a mental health workforce big enough to manage the problem that we have,” Victoria Hornby CEO of Mental Health Innovations, a UK nonprofit dedicated to helping young people find mental health resources online, said during a panel at WISH. “So we must start leveraging all of the technologies that we have available to us, in part to reach the people who are in need of help now and particularly to help young people who are in the early stages of distress.”
Shortage of trained professionals
It’s no secret that globally the mental health sector is facing a dearth of both trained professionals and financing, with the World Health Organization reporting that on average only 1 to 6 percent of health budgets are spent on mental health.
But some are working on technologies to address this chasm. For example, Trust Circle, a digital mental health startup, is teaming up with local governments and charities to screen young people for signs of potential mental illnesses. While the platform has multiple products, the point of entry is a mental health screening tool. The idea is for this tool to be given to students ages 15 to 24, similar to how schools administer physical wellness assessments.
The startup has been working with WHO to deploy the technology in southern India, with the main goal of early intervention and prevention.
The platform is designed to work with local entities to adapt the technology for their population and also gives the organization—whether that be a government or a nonprofit—aggregated anonymous data about the population. The tool can also give users the option to give their information to whichever organization is working with Trust Circle in this area—which in some cases could bring them to one of Trust Circle’s other tools that connect users to therapists.
“They are not only getting data analytics but they are channeling and tapping into its demand as well,” Sachin Chaudhry, founder of Trust Circle told MobiHealthNews. “They would know that at this point in time, in this region, at this organization, these are the demographics that are at risk, this is the number of frequency of requests coming in. Are we understaffed? Are we overstaffed? Should we change policies based on that? Should we shape decisions differently? Because without data you can’t do anything. Whether it is an organization, or a government, or a council, you have to have this data to convey the message that we are understaffed, under-resourced, under-funded, and hence you build a case for that.”
Another topic that has been commonly discussed in the space is bringing more community partners into mental health and not leaving all responsibilities up to specialized therapists.
Sachin said that Trust Circle is employing technology to help facilitate this and, in turn, to expand the access to care.
“I believe that technology for good is happening right now, but we have to make technology inclusive, which brings in people below the poverty line as well. So the way we did it was making it multilingual, accessible on any device, and simple enough so that community health workers can use it,” Chaudhry said. “Now community health workers are already going to these rural areas, tribal areas where people below the poverty line are living, to do other physical screenings. But now, with our solutions, they can go to them and get the emotional screenings as well.”
Meanwhile, Hornby, over at Mental Health Innovations, is looking to use folks who are trained but not necessarily mental health professionals as a way to help people get to the resources they need.
“A lot of young people we are talking to at the moment don’t believe they deserve help,” Hornby said. “Often the first barrier to people getting … help is for people to feel deserving of the support that they need, and that doesn’t need to come from a specialist.”
Addressing the stigma of mental health globally
While the industry is focusing on how technology could help alleviate the burden on the workforce, some in the field are also examining how it could be used to help people facing stigma.
“Perhaps the greatest challenge that this issue leads to is that stigma that has for such a long time persisted. People who are afraid to speak out and reach out, afraid to even admit to themselves that a mental health problem is developing,” Paul Farmer, chief executive of Mind, a UK-based mental health charity, said during one of the WISH panels.
Providing avenues for people to seek help and get treatment is key, according to Lord Darzi, but that can come in many forms including virtual.
“Although you see a lot has changed in the West I think globally there are still areas of stigma around mental health,” Lord Darzi said during a press conference in Doha on Tuesday. “Mental health is no different than physical health, you can address them, you can treat them. It may not be a pill you take over night and your fever disappears; it might be a different type of virtual pill that you can actually talk to someone. Talking is one of the most therapeutic things you can do.”
While most health professionals agree that in-person therapy should be the ultimate goal for treating individuals with mental health conditions, many are looking to online tools to kick off the conversation.
Hornby said that when developing the idea of Mental Health Innovations, which is a spin out of the Duke and Duchess of Cambridge’s Heads Together campaign, the team looked at where and to whom young people were most comfortable talking.
“There is a recent report in the UK that says over 65 percent of 18- to 24-year-olds would prefer to seek help online and would actively prefer to seek help online [as opposed] to family, friends and a therapist—at least in the beginning of their journey. We know [online] is where they start. So we need to meet people where they are,” Hornby said.
But it isn’t just young people that are turning more and more to digital resources. Dr. Neil Leibowitz, chief medical officer of Talkspace, a platform that offers therapy sessions via the web and mobile devices, said virtual therapy has been particularly effective in certain other demographics and treatment groups.
“We work very hard to create a safe space and want people to be comfortable. One of the things that has been interesting for us is our work on trauma. What you see is a huge drop out rate for most people with post traumatic stress — especially men,” Leibowitz said during a panel at WISH. “We are actually in the final stages of a study with Duke looking at PTSD and what we have actually found is, that people come online and some of that confidentiality and anonymity that they have creates a safe space for them and they open up.”
But many point out the online resources also offer a confidence to clients and patients that they may not have had otherwise.
Michael Phelps, a retired professional swimmer best known for being the most decorated Olympic athlete of all time, has publicly discussed his challenges living with depression. Phelps, who has since become a spokesperson for Talkspace, said that while he first accessed in-person tools, digital options provide folks with busy lives an alternative form of care.
“For me, when I was first starting therapy, I was afraid to call someone I didn’t know because I was afraid I would be treated or judged. For me it helped me to go to see someone a third party,” Phelps said during a speech at WISH. “But I also know how difficult it is with a busy schedule that we have to do that and take time away from work and take time away from our kids. Look how much we live on our handheld devices. It is kind of easy to pop in and chat with a therapist to see how you are doing, to see if you need help. … [A]nd for me being on the road a lot … I have to make sure I’m taking care of myself. So for me it is easy to pop on my phone and talk to my therapist on my phone.”
Possibilities and concerns
While the industry continues to move in a digital direction, many are asking questions about both the safety and legitimacy of the online space.
“There is a huge challenge associated with the impact of its use, particularly on young people. There is a need to consider carefully that digital technology can have both the power to help and to harm,” authors Sally Souraya, Thomas Canning and Farmer wrote in the WISH Anxiety and Depression Forum 2018 report. “For example, cyberbullying affects 23 percent of young people and is associated with the increased risk of depression, while peer-to-peer support benefits people who wish to share their experiences.”
That’s why many are pushing for validation and research. Leibowitz said that his organization has worked with partners to validate Talkspace and said that in the future he would like to see smaller grants available to organizations for the purpose of helping young startups research and test their tools.
But the digital realm also provides unique opportunities. For example, Dr. Sadriya al-Kohji, head of child and adolescent health service development and health promotion at the Primary Health Care Corporation in Qatar, said that digital has the potential to provide quality assurance of online treatment.
“I cannot go to the clinic and take a video saying how the physician is dealing with the adolescent, but the online one I can record for the purpose of evaluation,” al-Kohji said during a panel at WISH.
On the patient side, digital platforms often let patients look through previous treatments and access support tools.
“On a micro level we capture the conversations, so as a patient … you can go back and look at what your therapist said to you—maybe they sent you a breathing technique or a video,” Leibowitz said. “We also collect data, aggregate it and de-identify it, and do not sell it. We try to learn about what works and what doesn’t work. Unlike diabetes or hypertension, we don’t know as much about mental health as we think we do and one of the things that we would like to do is use that data to provide insight and how can we be better.”
Although there are still questions about what digital mental health tools will look like in the future, the need for the tools continues to push the industry forward.
“This isn’t one size fits all. This is about increasing access to services,” Farmer said. “[It’s] empowering people to be able to take control over their mental health needs through the digital route and connecting people with lived experiences.”
Date: December 5, 2018