New Frontier: Philanthropy’s Role in Digital Mental Health
Read ArticleMental health care is about helping patients manage their illnesses and overcome their challenges in the ways the work best for them. When governments across the country temporarily expanded access to digital health services in response to the Covid-19 pandemic, millions of Americans found a transformative answer to their long-unmet needs. Today, even as we enter Mental Health Month 2023, and as those emergency policies expire and barriers to access return, philanthropy finds itself suddenly and uniquely positioned to contribute to mental health along this digital frontier.
A Visible Crisis
Mental illness in America has been called an “invisible crisis” for so long that it’s no longer true. The evidence is overwhelming to anyone who looks. More than 57 million adults and 7 million children suffer symptoms every year.[1],[2]. The 40 percent increase in “feelings of persistent sadness and hopelessness” among U.S. youth between 2010 and 2019 — and 31 percent increase in teen mental-health related ER visits during the pandemic — forewarn a rising tide of emotional scarring for decades to come.[3],[4],[5]
Making matters worse, one of the leading contributors to the mental health epidemic is lack of access to care. Most Americans with mental illness go untreated altogether, and members of racial minorities get help in even fewer numbers.[6],[7] A 2022 survey found that 42 percent of Americans with behavioral health issues did not seek out care because of barriers like costs and limited insurance coverage.[8] That’s why significant increases in patients seeking help for mental illness since 2020 has been such welcome news.[9] As soon as lawmakers, payers, and providers embraced digital mental health technology during the pandemic, millions of Americans who had never sought psychological or behavioral counseling before did.[10]
And it worked.[11]
The Future Was Then
One study found “digital mental health services including telecoaching and teletherapy were effective in improving subjective well-being and clinical improvement in depressive symptoms.”[12] Another found that telepsychotherapy was as effective as in-person therapy for veterans with post-traumatic stress and seniors suffering depression.[13] More than 95 percent of clinical psychologists now offer at least some services remotely.[14] And 60-80 percent of Americans support digital mental health services and are open to using them.[15]
During pandemic social distancing, Americans embraced telehealth across all medical specialties. And it is not surprising that mental health care, which consists primarily of talking and listening, excelled among them during those stressful months.
Today, though, the rules governing digital mental health care are among the myriad things “going back to normal” now that the Covid-19 emergency has passed. But for digital mental health, the old “normal” means onerous access restrictions. The mental and behavioral health provider shortage did not disappear over the last three years. A majority of U.S. counties still lack a psychiatrist and 70 percent lack a child psychiatrist.[16] And demand for care continues to rise faster than policymakers at all levels of government can possibly update all the relevant statutory, regulatory, and budgetary issues involved.
All this is to say, we know digital tools can help America meet its large and growing mental health crisis. With more than 85 percent Americans owning smart phones, the potential for digital care is almost limitless.[17] Private investors certainly think so, pouring more than $8 billion into mental health enterprises in the last two years alone.[18] But we also know that digital mental health is still young — a dynamic, fluid field operating on the frontiers of technology, medicine, and public policy. What’s needed now is bold leadership that can harness all three sectors to create a bold new vision for digital mental health care that offers patients the best and most equitable care that private, public, and scientific partnerships can deliver.
And if digital mental health care is a frontier industry, then part of the work ahead of us is bringing some order to it. Enter philanthropy.
Philanthropy’s Opportunity
Philanthropic institutions are perfectly situated to innovate in the space between policy, business, and health care.
One high-value project would be vetting all the software and devices flooding the digital mental health market. Different apps will have different strengths and weaknesses — diagnostic, cultural relevance, user-friendliness. But to date, no one has comprehensively reviewed their various qualities.
Nor has anyone solved the problem of connecting minority communities with mental health professionals who share their cultural background — yet another hurdle to care and equity that digital apps could help solve.[19]
Apps also need to be created to be as safe and private as a visit to the doctor’s office. Companies and government health programs are more likely to cover apps that have met standards of safety and privacy, as well as additional criteria of clinical effectiveness. The UK, Netherlands, and Australia all currently fully reimburse for digital mental health care, showing what’s possible. And the sheer magnitude of technology’s scaling effect could also create opportunities outside traditional third-party reimbursement.
The U.S. Agency of Health Research and Quality recently proposed a framework for evaluating apps based on efficacy, privacy, and clinical relevance. The Society for Digital Health, a non-profit supported by philanthropy, is currently convening experts, practitioners, and policymakers to refine this work with an eye towards establishing standards and a pathway to reimbursement.
Artificial intelligence could have a role to play, too — helping patients, providers, and payers crunch the massive compilations of data about different mobile apps. Standardized analysis like this is a crucial step toward expanding access as quickly as possible, while also enabling real-time course corrections based on real-world evidence.
Eventually, the “killer app” for digital mental health may expand beyond evaluation into recommendation. One can envision a digital formulary modeled on the drug and medical device formularies that insurers and pharmacies use to make their coverage determinations.
The benefit of engaging philanthropy in this process is to build a tool that predicts more than dollars. Philanthropists could build the evaluation tool to catalogue apps that specialize in specific treatment modalities or serve specific at-risk populations with culturally competent providers – forecasting the social as well as the monetizable value of each app.
The fact is, there will always be some problems that private capital won’t touch: they are too complex, or the market is too small. On the other hand, government too often relies on the criminal justice system to cover its end of the problem. Police are now the default response to most mental health emergencies, which, from a broader perspective, is the opposite of the kind of inclusive, preventative, positive care mental illness needs. Rather than duplicating the work of private enterprise or public policy, philanthropy can take on the social needs now being left behind.
The gap between America’s mental health needs and mental health care can be closed. Everything we saw during the pandemic, and everything we know about personalized technology in other sectors tells us so.
Digital apps can bridge the gap between the fractured, unsustainable status quo to the inclusive, equitable, healthier future. By focusing on social returns while the market focuses on financial returns, philanthropy can catalyze these transformative innovations, reaching millions, even tens of millions of patients needlessly suffering without treatment, and shaping the future of both technology and mental health.
[1] https://www.nimh.nih.gov/health/statistics/mental-illness#:~:text=Mental illnesses are common in, mild to moderate to severe.
[2] https://www.michiganmedicine.org/health-lab/half-us-children-mental-health-disorders-are-not-treated#:~:text=Nearly 7.7 million children and,or ADHD, new research finds.
[3] https://www.apa.org/monitor/2023/01/trends-improving-youth-mental-health
[4] https://pubmed.ncbi.nlm.nih.gov/33180751/
[5] https://www.cnbc.com/2022/02/10/covid-pandemic-mental-health-damage-could-last-a-generation.html
[6] https://mhanational.org/issues/state-mental-health-america#:~:text=Over half (54.7%) of,illness did not receive care.
[7] https://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NSDUHDetailedTabs2020v25/NSDUHDetailedTabs2020v25/NSDUHDetTabs8-27,29,31pe2020.pdf
[8] https://www.thenationalcouncil.org/news/more-than-4-in-10-us-adults-who-needed-substance-use-and-mental-health-care-did-not-get-treatment/
[9] https://www.cdc.gov/nchs/products/databriefs/db444.htm
[10] https://www.usnews.com/news/health-news/articles/2022-09-07/study-shows-rising-demand-for-mental-health-treatment-during-pandemic
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387818/
[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387818/
[13] https://psycnet.apa.org/fulltext/2020-81589-001.html
[14] https://www.apa.org/news/press/releases/2021/10/mental-health-treatment-demand
[15] https://www.psychiatry.org/news-room/apa-public-opinion-poll-2021-access-to-care
https://www.nami.org/NAMI/media/NAMI-Media/Research/NAMI-Mood-Disorder-Survey-White-Paper.pdf
[16] https://www.mckinsey.com/industries/healthcare/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
[17] https://www.zippia.com/advice/us-smartphone-industry-statistics/
[18] https://bhbusiness.com/2023/02/10/2022-mental-health-tech-funding-down-53/
[19] https://psycnet.apa.org/record/2018-41797-001