Innovation -
Digital Tools Are Revolutionizing Mental Health Care in the U.S. - Sun and Planets Spirituality AYINRIN
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We have a crisis in mental health care in the United States. Sixty percent of young people with major depression received no mental health treatment in 2017-2018, and one quarter of adults with mental illness reported an unmet need for treatment. In the U.S., 55% of counties have no psychiatrist, psychologist or social worker, and 70% don’t have a single child psychiatrist. Queues for substance abuse care can be weeks long; 70%
of those who needed substance use treatment in 2017 did not receive it.
To make it worse, many practices have closed or reduced their capacity
in response to pandemic health concerns.
Insight Center
Because
of the pandemic, virtual care and other digital tools are more
important than ever in supporting existing care, providing scale and
increasing capacity. Clinician-based virtual care replaces traditional
in-person office visits with synchronous video or audio visits or with
asynchronous text messaging. This provides alternatives to the
traditional 50-minute therapy hour and allows for a better match of
supply and demand across times of day and geographies. Asynchronous
messaging, for example, lets patients text a clinician or coach at any
time and get a response later.
Non-clinician
based digital mental health services, such as chatbots, video and
written content, gamified user exercises and digital cognitive
behavioral therapy (CBT) programs, are a good adjunct to clinician-based
virtual care, allowing 24/7 access for those with less intensive needs.
Increasingly,
innovative mental health vendors are combining digital tools and
virtual care to create a robust ecosystem for end-to-end patient care,
including steering patients to in-person care when needed. This
combination of tools provides the mental health care system with
scalable solutions and increased flexibility while improving access and
convenience for consumers. Because of these benefits, the majority of employer-sponsored health plans now offer virtual and digital options for mental health care.
Effectiveness
How well do digital services and virtual care work? A 2016 metanalysis of 452 studies of telepsychiatry found high patient satisfaction and quality equivalent to in-person care. And a 2020 Veterans Administration study found that video telepsychotherapy
was as effective as in-person office-based care for treating depression
and post-traumatic stress disorder. Overall, most published studies
show telephonic mental health care is as effective as in-person care in treating depression, anxiety and obsessive-compulsive disorder.
Similar
results have been generated by digital tools that provide animated
and/or human video instruction, content libraries and exercises. Digital
CBT programs have proven as effective as in-person CBT in treating anxiety and depression and insomnia. One randomized, placebo-controlled trial of web-based CBT for insomnia
demonstrated improvements in sleep quality and wakefulness. That
technology, marketed today as Sleepio, has been implemented by many
large employers. A chatbot developed by Woebot which provides CBT, DBT
(dialectical behavior therapy) and mindfulness support led to significant improvement
in young adults’ anxiety and depression in randomized clinical trials.
And meQuilibrium, a stress and resilience app and program now available
through many employers, showed a significant positive dose-response effect on stress and related symptoms in enrollees in a digitally administered resilience program.
Each of these types of care solutions can be delivered in a HIPAA-compliant manner with appropriate privacy protections.
Scalability and Access
Ginger
is an on-demand support program that guides users in addressing
low-acuity mental health care needs, such as mild depression or anxiety,
through secure texting with trained coaches supervised by therapists
and supported by artificial intelligence. (Many virtual care platforms
use algorithms to match users to providers; there’s some evidence
this can increase patient satisfaction and even clinical efficacy.)
With Ginger, patients are escalated to a therapist or physician if they
request it, or if the AI or coach recognizes the need for escalation.
Coaches focus on needs including stress management, goal attainment, and
recovering from loss using tools such as motivational interviewing and
app-delivered content. By addressing less acute issues directly and
triaging people to therapists or physicians as needed, the program
provides scalable, cost-effective support. Ginger is offered directly by
many employers, is in-network with several health plans, and counts
Cigna and Kaiser Permanente among its investors. Vendors, including
Spring Health, Lyra and Modern Health, likewise provide a continuum of
care from addressing low-acuity needs to triaging users to more advanced
care.
Talkspace,
a platform with more than a million users, also scales access as it
connects users to licensed providers. Members or employers pay a
subscription fee for unlimited 24/7 access to therapists via texts,
voice messages and/or videos within their secure application. Members or
employees can also schedule video or phone sessions with a therapist as
needed. While traditional 50-minute sessions are available, much care
is delivered in small bites, allowing therapists to care for more
patients and have more flexible schedules.
In
addition to the scheduling flexibility and efficiency of therapy such
platforms offer both patients and providers, these digital solutions
have the potential to lower practitioners’ overhead. (They needn’t have
an office.) They also broadly increase access at potentially lower cost
to patients and employers than the cost of providing traditional
face-to-face care to the same population.
The Path Ahead
The
Covid-19 pandemic led to a dramatic increase in the use of virtual and
digital mental health services. The pandemic and associated lockdowns left more patients in need
with little choice but to move away from in-person care. Clinicians who
had resisted virtual visits faced devastating loss of income, and they,
too, moved online. However, maintaining and building on the gains in
access to care will be key. Many users and clinicians have had good
experiences with digital tools and virtual care, and their availability
and use can help us meet our mental health needs as the pandemic
recedes.
Clearly,
virtual and digital care isn’t for everyone, and is inappropriate in
some cases – for instance in most emergency situations. But virtual and
digital care can improve affordability and provide critical additional
access for those in need. In a study on virtual care, Accenture reported
that 46% of patients “would choose to receive mental health
appointments virtually.” Those in Gen Z (born in 1997 or later) were
more than four times more likely than Baby Boomers to prefer virtual
care to in person care. In addition, some communities which have historically faced stigma and discrimination may prefer virtual or digital care.
The
pandemic has put a spotlight on the value of digital and virtual mental
health care, and by doing so might have thrown a lifeline to our mental
health system. If we can harness learnings from the pandemic to drive
increased, appropriate use of digital tools and virtual care, we can
significantly improve the long-standing problems of inadequate access to
mental health services. Critically, digital tools and virtual care will
allow us to effectively meet the mental health needs of more Americans
than ever before.
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