In recent years, a growing number of tech startups have promised to disrupt mental healthcare and increase access. But is their vision of the future the one that’s best for patients?
For a long time, I thought the answer was absolutely not. Shaped by coverage of ethical lapses and financial waste, my perception was that many of these companies were led by founders who were at best careless and, at worst, outright exploitative.
I know I’m not alone in that perception. I’ve spoken to many therapists who care deeply about inequities in mental health and are skeptical, perplexed, or fearful of what’s happening in mental health tech.
My own view changed as I started to appreciate the nuances of tech innovation, business, and the role of clinicians in these companies. There are dozens, possibly hundreds, of mental health tech companies! Clinicians are founders or leaders in many of them. It’s not just tech bros.
The reality is that tech has the funding and the talent we need to fix mental healthcare. Not everything that these companies do will improve access to care, but some of it will. It concerns me that such a gulf exists between two groups of potential allies in the fight for equitable access to care.
As clinicians and advocates, the more we know about mental health tech, the better we can position ourselves to benefit from, get involved with, and shape this work. Being well-informed will also help us protect ourselves and the public when we anticipate companies may cause harm.
I see mental health tech innovations falling into four broad and non-exhaustive categories:
The four categories are too much to fit into one Progress Note, so I’ll just write about the first one. It’s the biggest category and also the one that I find most intriguing as a clinician.
I define therapeutic tools and interventions as products designed to improve a user’s well-being. They can help with concerns ranging from situational stress to PTSD, and are developed as self-serve supports, adjuncts to therapy, or even replacements to traditional therapy. These products are usually marketed directly to consumers but can also be marketed to intermediaries like employee assistance programs, insurance companies, and therapists, who then offer them to help-seekers.
The quality and effectiveness of these products vary widely. There may be as many as 20,000 mental health apps on the market today, many developed by hobbyists and aspiring entrepreneurs. But there’s also a subgroup of apps designed with more rigor and clinical expertise by research groups and government agencies, like COVID Coach from the VA. Some of the products I find most exciting incorporate artificial intelligence (e.g., Woebot). Others, like Supportiv, provide a platform for connection with others for peer support, an underutilized source of mental healthcare.
(Check out the nonprofit One Mind PsyberGuide, which evaluates mental health apps for credibility, user experience, and transparency.)
Do these products actually work? It’s hard to say. But some products are designed with clinical efficacy as central to their value proposition. The class of products called digital therapeutics (DTx) undergo clinical trials to provide evidence of similar or better outcomes as traditional mental health services. For example, Sleepio is a DTx using CBT to treat insomnia. Prescription DTx, like EndeavorRX for ADHD in children, have received approval from the FDA to be prescribed like medication.
Some concerns with DTx are that therapists typically don’t have prescription privileges, their efficacy claims may be exaggerated, therapists are insufficiently involved in regulatory decisions, and insurance companies may not cover these interventions.
Despite the concerns, DTx are gaining ground. Highmark, a large private insurance company, recently made headlines as it became the first large insurer to cover digital therapeutics.
Technology, for better or worse, allows us to do things faster, more efficiently, and on a larger scale than traditional methods. Mental health tech companies have the potential to leverage these strengths to fix some of the biggest problems in our broken mental health system.
When guided by clinical expertise, I have no doubt that digital health companies will effectively tackle major barriers to care and deliver the innovation we desperately need.
I’m excited for what will happen as clinicians continue to increase their knowledge of and presence in mental health tech.
Let’s make progress together.
This edition of Progress Notes was first published in our quarterly newsletter.