Many digital products in behavioral health aim to ‘worry well’. Those seeking to develop solutions for mental illness need to involve clinicians and patients in designing products.
As America’s mental health crisis continues to grow, more innovators are creating digital health solutions aimed at behavioral health.
But as a panel at the HLTH conference showed last week, many of those solutions are not aimed at serious mental illnesses.
Andy Hamm oversees the Treatment and Preventive Interventions Research Branch at the National Institute of Mental Health, which focuses on developing solutions to treat mental illness. He acknowledged that it is more difficult to get regulatory approval for software tools for mental illness.
“It’s much more difficult than finding a product that circulates in a concerned well,” Ham said.
Patrice A., CEO and co-founder of eMed, a digital health company and former president of the American Medical Association. Harris said it was time to engage with regulators to discuss ways to make it easier for the market to settle.
Digital health entrepreneurs need to include people working in the trenches throughout the entire development process, said Virna Little, co-founder and chief clinical officer of Concert Health. That component is important, she said.
“Sometimes I think it’s not there,” Little said.
Vindell Washington, CEO of Onduo and chief clinical officer of Verily Health Platforms, said that innovators should look to the mental health community to create a solution that is not only elegant but “is something that is changing lives.”
“It is very easy to be overconfident in the design of the solution,” Washington said. Innovators need to have humility and “understand that you don’t know everything about that community.”
Harris pointed to another example of well-intentioned digital solutions that didn’t live up to expectations: electronic health records. Doctors were not involved in the design of health records, he said, and electronic health records have become a major cause of burnout among physicians.
“Lessons learned go to the end user. Go to the patient,” she said.
“We need to go out into the community and say, ‘What do you need? What do you need, and help us develop it.'”
Undoubtedly, mental health needs are on the rise. According to the Kaiser Family Foundation, during the COVID-19 pandemic, four in 10 adults have reported an anxiety or depressive disorder, up from nearly one in 10 adults before the pandemic.
According to the Centers for Disease Control and Prevention, suicide among young people is on the rise and is now the second leading cause of death among young people. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association have called on President Biden to declare a national emergency to address the growing mental health crisis among America’s youth.
Harris pointed out that with bipartisan interest on Capitol Hill and the attention of the C-suite, this is an unusual opportunity to develop new ways to deliver mental health services. But she said a number of different systems would need to be part of the solution. He also called for more federal investment in mental health.
The panel also discussed the inclusion of behavioral health in primary care. Health groups including the American Medical Association and the American Psychiatric Association are pushing for the integration of mental health and primary care.
Little said primary care doctors usually don’t think about how different care is for people with mental illness. She said she asked primary care physicians how treatment differed for patients with diabetes if the patient is bipolar “and there was no answer.” It’s one thing for a doctor to talk to a diabetic patient about the importance of exercise, but someone with a mental illness may not be able to leave the house to exercise.
“There are more opportunities to get primary care involved in getting better care or to think about how they are providing care in this community,” Little said.
Haim noted the difficulty in getting primary care physicians involved in the research, with doctors generally saying such studies are good but they are too busy.
“Embedding sticky solutions into primary care focused on mental health is going to take time,” Haim said.
Harris cautioned against blaming primary care doctors, who are seeing large volumes of patients in 15-minute blocks. The panelists agreed, however, that primary care doctors need to be part of a broader solution to improving mental health.
When asked what the National Institute of Mental Health is seeking in applications for funding digital solutions, Haim cited the importance of working with stakeholders in behavioral health.
Innovators need to have a clear idea of who is going to use their solutions, and how they will be implemented, such as how they integrate with electronic health records.
“We expect stakeholders to be involved,” Haim said.
Ultimately, Haim said innovators must demonstrate that those solutions actually work in practice, and can be sustainable.