Introduction
Today marks the first day of Mental Health Awareness Month. Since 1949, May has served as a month where many companies, non-profits, and other individuals have sought to increase the support for and public education around mental illness in the United States.
Mental health is defined as our emotional, psychological, and social well-being, ultimately affecting how we think, feel, and act. There are very few experiences that are truly ubiquitous among humans, but I believe mental health to be one of those experiences. Each individual has some degree of mental wellness that ebbs and flows throughout their lifetime, along with a high likelihood of either suffering from mental illness or coming in contact with someone who is suffering.
There are currently over 400 companies in the behavioral health / mental health technology space (!) that are working to solve the biggest problems in mental health, including access to therapy, diagnostics, andaccess to medication.
The following blog post serves as a primer for folks interested in the mental health technology space, outlining six segments of companies in hopes of elucidating the efforts of so many to improve mental health.
The Need for Innovation to Alleviate the Mental Health Burden
To understand why so many mental health technology companies exist, you need to understand the current burden mental health poses. Here are three figures that illustrate the pressing need:
- More than 1 in 5 adults in the United States live with a mental disorder
- Suicide is the 11th leading cause of death in the United States. Even scarier, suicide jumps to the second leading cause of death for children ages 10–14 years old and adults 25–34 years old
- As a society we spend an estimated $280 billion each year to treat mental illness
And, things are not getting better. Despite increased access to therapy, medication, and other treatments, more Americans than ever before are reporting mental health concerns.
So, if things seem to be getting worse, how do we radically change the trajectory of the mental wellness in the United States?
We need innovation. Fundamentally, to innovate means to “make changes in something established, especially by introducing new methods, ideas, or products”. We desperately need new products, methods, and ideas to help our mental health epidemic.
The Mental Health Technology Ecosystem
In a broad sense, an ecosystem is a set of companies that create and share collective value for a common set of customers. Within the mental health space, there are a number of different companies creating value for a number of customers.
Who They Serve
Typically, companies within the mental health technology ecosystem serve one (or more) of the four following customers:
- Patients: Also often referred to as clients in the behavioral health world, patients are those that are seeking care for their mental well being.
- Payers: Also known as health insurance companies, payers are the ones who typically pay (either partially or wholly) for mental health services.
- Pharmaceutical companies: Pharmaceutical companies are often focused on drugs to treat mental illness and digital therapeutics.
- Providers: These are individuals who administer or provide behavioral health services, typically therapists or psychiatrists.
However, specifically in the pursuit of treating behavioral health concerns, there are a number of other stakeholders who may be looking for solutions, including:
- Parents & families: Especially in the case of pediatric mental illness, parents and other family members are an essential stakeholder to ensure the wellness of the child.
- Schools: Schools can be the first place where mental disorders are noticed and diagnosed, especially in the case of learning disabilities and ADHD.
- Employers: Similar to schools, employers have a vested interest in ensuring the mental wellbeing (and thus, productivity) of their employees.
- Primary Care Physicians: Technically, primary care physicians (PCPs) are providers as noted above, but are not often the main administrator of mental health care. However, if an patient has a PCP, they should be kept in the loop with any medication or therapy being conducted.
What These Companies Offer
Before we dive into the categories of companies in the mental health technology space, I want to give a quick disclaimer. It is difficult to wrap all of the nuance of 400+ companies into a single blog post, and there are also a million different ways to segment the market. For example, the market can both be segmented by what the company offers or the disease spaces they specialize in. For this blog post, I aim to separate companies by what the company’s main offering is.
Now without further delay, the general mental health technology ecosystem can be segmented into six broad categories:
- Therapy Access: These companies focus on providing access to psychotherapy and medication for mental disorders.
- Clinician Tooling: These companies focus on technology that eases the administrative burden placed on providers.
- Diagnostics: These companies aim to streamline the diagnosis of mental illness.
- Digital Therapeutics: These companies develop and administer medical interventions that use evidence-based, clinically evaluated software to treat mental illness.
- Wearables: These companies provide wearable devices to improve mental health.
- Self-Guided Help: And lastly, these companies focus on providing content, resources, and guides for increasing mental health and wellness.
Let’s dive in.
Therapy Access
For a variety of reasons, accessing the proper therapeutic treatment is a chief concern among those with mental illness. Difficulties in finding help include a shortage of providers, long waitlists, or the inability to navigate a complex provider landscape. Companies focused on increasing access to therapy are solving all of these problems, and more.
Therapist Networks
The biggest category within the therapy access category includes companies whose main offering is a network of therapists. These companies aggregate providers into a centralized platform, making it easier to search for and connect with a licensed therapist.
Care Navigation
If you have ever tried to find mental health care for yourself or a loved one, you most likely understand that finding mental health care is hard. Prospective patients are met with a confusing list of alphabet soup (what is PhD v. LCSW v. PsyD?!) and providers often have months-long waitlists. The companies above focus on helping patients navigate finding the right provider for their symptoms and insurance, usually through technology such as matching algorithms and automated benefits verification.
Therapy Programs
Companies in this segment focus on providing therapeutic programs, usually eight to twelve weeks in duration, providing a bit more structure to recovery. Companies in this space typically focus on eating disorders, substance abuse, and autism spectrum disorder.
Employee Assistance Programs
These companies focus on selling directly to employers as a mental health benefit for their employees. These companies focus on mental wellbeing and therapy access for employees, along with providing dashboards for leaders on the wellness of their teams. These companies provide access to licensed providers, rather than just coaching or self-help resources.
Medication Development & Access
There are many companies working on medication development, but here we are focused on companies that are almost primarily focused on the mental health space. Within the medication development category, most of these companies spend their time identifying novel formulations to treat a variety of disorders, including schizophrenia or treatment resistant depression. Within the medication access category, most companies are focused on providing access to psychologists that can easily prescribe the right medications for your needs.
Clinician Tooling
This segment of companies focus on creating software and tools to make the lives of providers (in this case, therapists and psychiatrists), easier. This includes automating manual administrative tasks tasks or providing technology to help providers grow their practice. Much of clinican tooling segment aims to solve clinician burnout by reducing the amount of administrative tasks therapists have to complete.
Care Operations Automation
Care operations is broadly defined as any activities that a provider or clinic must do to make a place where care is received run smoothly. These companies aim to automate everything that is not providing direct care to the patient, freeing up the therapist’s time. The end goal here is to enable therapists to see more patients rather than spending their time doing administrative work such as note taking, billing, patient intake, and benefit verification.
Electronic Health Record Systems
In the past, the big electronic health record systems(think, Cerner or Epic) have not been optimized for behavioral health practices. Typically, they are too expensive for most practices and not designed for their needs. As such, a crop of companies has popped up specifically focused on electronic health record systems designed for behavioral health, focused on unstructured notes and the ability to document complex psychiatric disorders.
Measurement Based Care
Generally, measurement based care refers to using patient-reported outcomes (usually from self-reported questionnaries) to guide treatment. These companies provide software to easily collect data from patients and document trends over time. This allows the therapist to keep tabs on their patients and dig into areas where the patient is still struggling.
Post-Therapy Interventions & Remote Patient Monitoring
Generally, therapy is most effective when the strategies suggested by the therapist are applied in everyday life or medication is taken daily. These companies focus on making the connection between therapys sessions and day-to-day life as seamless as possible, creating applications where patients can track their activities, participate in self-guided content, and provide data back to the therapist on adherence and progress.
Diagnostics
Today, all diagnostics for mental disorders are based on the Diagnostic and Statistical Manual 5 (DSM-5). Companies in the diagnostics space are developing novel biomarkers that can be used to detect mental illness (later to be confirmed by the criteria in the DSM), along with user-friendly interfaces for surveys used for screening.
Biophysiological Markers
Many people working on improving behavioral health have been searching for biophysiological markers of mental illness for years. Although still elusive, these companies are working on developing markers from biopsychological markers such as the electricity in the brain can point towards possible mental dysfunction.
Voice
As a subsector of companies focused on biophysiological markers, there are a number of companies that are using voice records to identify signs of anxiety, depression, and risk of suicide. These companies have developed the ability to identify risk for mental illness based off of the voice of an individual. There are a number of very interesting applications for this technology, including implementing a background “listener” for suicide hotlines to determine the severity of suicidal ideation in callers.
Tech-Enabled Diagnostics & Screenings
A big problem in the mental health world is ensuring that folks are getting screened, diagnosed, and connected to the care they need regularly. Companies that are working on technology to help aid the screening and diagnostics process focus on disorders ranging from Autism Spectrum Disorder to dementia. Additionally, companies such as Neuroflow can comb through the data contained in a medical record to flag patients that are at high risk of mental illness due to comorbid factors. The result of innovation in this space will be that adverse mental health conditions are being identified at a more accurate rate.
Digital Therapeutics
Digital therapeutics (DTx) use software programs to deliver evidence-based and clinically validated interventions meant to diagnose, treat, or prevent mental health disorders. It is important to distinguish between DTx that have been approved by the Food and Drug Administration (FDA), and therefore have been clinically validated, and those that have not.
Application-Based Therapy
As the United States battles with a shortage of providers, many companies have been exploring how asynchronous therapy can be delivered through applications. These companies focus on creating effective therapeutic programs that can be done without meeting with a provider face-to-face. Today, Freespira, Click Therapeutics, and Akili have all been approved by the FDA.
Virtual Reality
Another avenue for digital therapeutic administration is through virtual reality technologies. Often focused on feelings of anxiety, lonliness, or post-traumatic stress disorder, these digital therapeutics allow users to interact with others in a virtual setting or complete exposure therapy to stressful situations.
Wearables
This is a segment of the behavioral health technology landscape that is still pretty nascent compared to other segments as there is still a lack of scientific evidence behind many of these offerings. Some of these wearables provide brain stimulation to treat mental health disorders, while other companies are developing brain-computer interfaces to hopefully serve future use cases such as helping those who are paralyzed.
Self-Guided Help
And last but certainly not least, we have our self-guided help category. Companies in this category focus on non-clinical support for mental illness. It is important to note that coaching takes many forms, but is differentiated from psychotherapy as it is not administered by a licensed clinician. Often times, these applications will focus more on mental wellness (which everyone needs to work on) rather than just those that are suffering from a clinically diagnosed mental illness.
Peer-to-Peer Support
Companies in this category often provide virtual support programs or peer-to-peer connections to help those struggling with mental illness. This can be anything from a community of individuals coming together to discuss topics surrounding mental wellness or “professional listeners” who are trained to support those with mental health needs in a non-clinical setting.
Self-Guided Learning & Therapy
Another approach to expanding access to mental health care is to provide self-guided applications and programs that patients can engage with in their own time. These applications range from journals focused on those with anxiety to providing cognitive-behavioral therapy content on-demand. The goal of these applications is to give patients the tools and skills needed to increase their mental well-being on their own time.
Tracking
Tracking day-to-day symptoms of mental wellness is essential to understanding mental health trends over time and ensuring overall well-being. A lot of these applications prompt users to track symptoms on a daily basis, whether as part of a standardized program or as a stand-alone offering.
Meditation & Sleep
Both adequate sleep and meditating have been shown to have positive effects on overall mental wellness. These applications aim to provide easy to use applications and programs that help people feel calm, meditate, and sleep better for longer.
Employee Engagement & Tracking
As mentioned previously, employers have a great stake in ensuring that their employees are mentally well and productive. Due to this need, there are a number of companies that currently sell to employers as tools to engage employees and track mental wellness. These companies often provide data collection tools and dashboards for leaders to see how their employees are doing and/or provide daily coaching or content for employees to learn from.
Coaching
When discussing the coaching category, it is important to distinguish coaching from psychotherapy. Coaching is not conducted by a liscened provider and often focuses on less-severe to non-clinical mental illness such as mild anxiety, stress, or grief. With that said, these companies provide coaching for a variety of different reasons, helping indiviudals navigate the ups and downs in their lives.
Chatbots
Chatbots are being used increasingly to augment mental health care. Often powered by artificial intelligence, chatbots can correspond with individuals seeking behavioral health care providing real-time support, conversation, and mental health support on-demand. Although an interesting way to expand mental health care, critics of chatbots for mental health care point towards unknown effectiveness or the risk of providing inadequate or harmful advice.
Conclusion
As you can see, there are hundreds of companies that are working to solve the biggest challenges in the mental health space. As these companies continue to grow and we see new companies enter the scene, I am hopeful that we will start to see meaningful improvements in our mental health.