Even before the COVID pandemic, one in five Americans suffered from a behavioral health condition, yet less than half had access to treatment. The pandemic increased the number of people experiencing behavioral health challenges, thus increasing pressure on a healthcare system already struggling to meet this need.
Despite federal law that theoretically requires insurance coverage for behavioral health in parity with other health conditions, affordable care remains elusive for many. Coverage inequities persist, costs can be high even with coverage, and there is a shortage and uneven distribution of behavioral health professionals. Stigma creates barriers as well. This remains the harsh reality in the U.S.
As with all things these days, there’s an app for that: approximately 20,000 of them available for download to help people with depression, anxiety, substance use disorder, post-traumatic stress disorder, attention deficit hyperactivity disorder, stress, burnout, eating disorders, wellness, postpartum depression, and so forth.
Since 2016, the number of behavioral health digital apps on the market and their popularity surged. Usage further accelerated last year as the pandemic exacerbated behavioral health distress, telehealth regulation were loosened, and as people became more comfortable using tele- and digital health modalities.
Investors are smitten. During the first three quarters of 2021, venture capital investment in digital behavioral health soared to $3.1 billion, already surpassing the $2.4 billion raised in 2020, which was more than double the 2019 mark. Digital mental health has attracted the most money of all clinical indications so far in 2021, beating runners-up cardiovascular disease, diabetes, primary care, oncology and substance use disorder. Note the latter is also in the behavioral health category.
Digital solutions promise to fill the gaping holes in the current behavioral health system.
For individuals, digital direct-to-consumer apps provide access to treatment right away at a time when new patients can face months-long waits to get an appointment with a local behavioral health clinician.
Several apps connect patients with licensed behavioral health professionals for therapy by phone or video or even coaching via text. Patients needing medication can access psychiatrists for prescriptions and medication management. Apps for substance use disorder (SUD) patients can link them with psychiatrists/clinicians for medication assisted treatment (MAT), licensed therapists for counseling, peers, support groups, and other recovery services.
Wellness apps abound that provide coaching, relaxation and mediation techniques, breathing exercises, smoking cessation programs, mood trackers, mindfulness training, and games to help people recognize and manage their conditions. Many digital apps involve no clinicians or humans. Chatbots and programs profess to provide cognitive behavioral therapy, services and treatment driven by emotional artificial intelligence (AI).
Most apps charge a monthly or annual subscription fee that may be covered by insurance with additional services available a la carte. Other digital-solution companies contract directly with employers or insurers.
Digital apps also assist behavioral health clinicians who were already stressed but now have been pressed to the limit by COVID. Many digital tools are intended to be used in tandem with traditional care to help clinicians with the diagnosis and treatment of patients. Clinicians can prescribe other digital apps for patients to use to reinforce their care.
Another powerful addition to the caregiver’s toolbox is data: data collection via wearables and trackers to inform clinicians about patients and data analysis and AI to enhance assessment and, on a macro level, advance science and research.
Digital solutions also help hospitals and health systems augment their current cadre of behavioral health services. In an ideal healthcare system, all patients would be screened for behavioral health concerns at all entry points of care. Millions of people have issues that are discounted, ignored or not recognized. If not screened, caregivers are unaware and patients at risk go untreated. Yet without enough behavioral health providers, physicians and health systems sometimes hesitate to screen because they have nowhere to refer patients for follow up care.
By incorporating a digital health platform into treatment options, health systems can screen more people and extend current medical staff and workforce to provide access to those who need behavioral healthcare, including those who likely never would have sought care on their own. Another strategy is to use what’s called a step-care model, according to David Mohr, director of the Center for Behavioral Intervention Technologies at Northwestern University’s Feinberg School of Medicine, which would allow patients with milder symptoms to be treated via technology, reserving in-person care for patients with stronger or more immediate concerns.
Finally, health systems are using digital apps to provide support and comfort to their workforce, particularly helpful during recent times of extreme stress.
Digital solutions have potential to ensure everyone gets the behavioral health care they need. Next step in the evolution of the digital health revolution -- figuring out which of all these apps performs as promised and is the right fit.