Technology’s Role in Increasing Access to Mental Health
We believe novel technologies will play a fundamental role in increasing access to mental health and wellness, and will help shift the conversation on who should get access to them.
Before we look at the future and try to understand how technology will impact access to mental health, it’s helpful to define what exactly we mean by access. To us, access means that everyone who is in need of mental health care also has the opportunity to obtain it. While the traditional view primarily considers access to treatment for individuals with diagnosed mental health conditions, we believe everyone should have access to the tools and practices to nurture better mental wellness. The journey to flourishing mental wellness doesn’t start in hospitals or psychiatric settings, it begins with self-care and is a process that requires continuous engagement.
Currently, many individuals with mental health conditions don’t receive adequate treatment. While not a silver bullet, technology holds great potential in breaking down barriers and increasing access to both treatment and preventative solutions more broadly.
The obstacles to access
The Covid-19 pandemic has put our mental health in the spotlight. Rising rates of depression and anxiety has created greater awareness of our mental health needs in all corners of society. Waiting in the hope that things will sort themselves out is clearly not an option. Before the pandemic, depression was already the leading cause of disability worldwide and almost 11% of the world population had one or more diagnosed mental health conditions. In the European Union, this number is even higher — mental health disorders affect more than one in six people in any given year. Despite these alarming numbers, mental healthcare around the world remains seriously underfunded which, when left unchecked, continues to impose enormous costs on governments and societies. In the EU, the annual economic impact of mental health issues (including loss of productivity) is €600 billion — or 4% of GDP, exceeding the burden of cancer, diabetes, cardiovascular and respiratory disease combined.
The shortage of funding in mental healthcare impacts access to mental health services. It contributes to a huge treatment gap with a high percentage of those in need of mental healthcare not receiving it. In Europe, 45% of people with major depression and 40% of people with bipolar disorder do not obtain adequate care. The median time to receive psychiatric assessment and appropriate psychotropic medication in Europe is between 7 days and 1 month (with even longer waiting times for those seeking psychotherapy).
Structural barriers, such as high cost or geographical constraints (e.g. living in rural areas where mental health professionals are sometimes non-existent), also prevent people from seeking treatment. Especially in countries like the United States and Russia where universal health coverage is largely unavailable, low-income individuals are more likely to report financial barriers to accessing mental healthcare. When mental health conditions are untreated, people are also deprived of the opportunity to live fully and contribute with their full potential to their families, communities, and societies. This, in turn, contributes to further exacerbating already existing systemic inequalities, widening not only the gaps between socioeconomic groups but ultimately also the mental health treatment gap.
Furthermore, social stigma, public awareness, and low perceived need for treatment prevent individuals in need of help from seeking it. Although stigma is slowly dissipating, negative images and misconceptions still exist. They stop people from talking openly about their mental health and from seeking help out of fear of being judged.
Finally, to create a future of mental health that is accessible and inclusive to everyone, we need to look beyond the current horizon and develop new approaches. Traditional range of solutions are largely treatment-oriented and clinical. However, for flourishing mental wellness to be achievable by all, we need to expand and diversify solutions and focus on preventative practices as well. At Masawa, we believe that technology, while not a cure-all solution, has an important role to play as a driver of innovation in making mental wellness — both treatment and prevention — available for all.
The role of intention in tech
In the context of our well-being, we mostly hear about technology’s negative impact. Our heavy smartphone use negatively affects our mental health, social media appears to have fundamentally changed the nature of our peer and family relationships, and our attention tends to be consumed by mobile devices, contributing to a lack of awareness of our immediate surroundings. Many of us see, interact with, and interpret the world through the lenses and screens of our smartphones, rather than by fully immersing ourselves in direct sensory experience. However, as the past teaches us, every novel technology is never neutral: it has the potential to be both life-enhancing and life-destroying. As part of our impact thinking, we place a high value on founding teams’ intentions, motivations, and awareness about the technology they are developing. We want to understand how they think their innovation will contribute to increased well-being, both in scale and in depth. There is no room for innovators that exploit human vulnerabilities, perpetuate injustices and division, and turn a blind eye to the negative effects they create.
An evolving ecosystem
Although public funding is still some way off, global private investment in mental health has increased five-fold over the last 5 years. In 2020 alone, nearly $1 billion of venture capital went to US mental health startups, a 112% increase compared to 2019.
Policy makers, aware of the enormous costs mental ill-health imposes on healthcare systems and society, are increasingly adopting prevention first strategies. Such strategies focus on promoting healthy emotional and cognitive functioning with the goal of preventing the onset of mental health disorders, which carries enormous cost-saving potential. New regulatory frameworks increasingly contribute to creating a favorable environment for businesses innovating in the mental health space. For instance, Germany’s Digital Healthcare Act allows doctors to prescribe healthcare apps approved by the Federal Institute for Drugs and Medical Devices (e.g. online psychological courses for depression and anxiety, such as Hellobetter’s) which are provisionally reimbursable by the statutory health insurance. The US FDA, aware of how slow and ultimately unfeasible it would be to approve every new update or change to a technological product, introduced the Digital Health Software Precertification Program. This program allows regulators to first assess the developer instead of the technology developed, enabling product development and go-to-market to occur more efficiently and rapidly.
How technology is increasing access and breaching barriers
There are several ways mental health startups are using technology to increase access to mental health services. Online psychiatry and therapy (e.g. BetterHelp, Amwell), which are proven to be as effective as in-person therapy, are breaking down structural barriers to access, by making mental health services more widely available and convenient for people living in rural or remote areas. Online mental health services are also less costly, since they better match mental health professionals with patients, and minimize overhead and transport costs associated with face-to-face sessions.
To ensure the mental wellbeing of young people, the future requires more attention to and investment in early prevention. Today, 50% of mental health disorders are established by age 14 and 75% by age 24. Self-harm is the third cause of death among 15–19 year old adolescents and loneliness is on the rise. Experts agree that children and adolescents must cultivate self-awareness to learn to understand and self-regulate their emotions. This will make them better able to deal with stress and anxiety both in their childhood and later as adults.
For this reason, investors and healthcare systems are starting to look at Digital Therapeutics (DTx). These are evidence-based therapeutic interventions delivered through software with the goal of preventing and managing mental health conditions as well as promoting mental wellness. They can be prescribed by medical doctors and are oftentimes reimbursed by insurers. One promising innovation are digital therapeutic games (e.g. Endeavor Rx) that help children improve cognitive and emotional functioning in a highly-immersive and playful way. In-game incentives like points and rewards stimulate positive behavior such as practicing breathing techniques and building emotional regulation skills. DTx that incorporate machine learning can obtain real-time data that provides better insights into children’s in-game developments, learnings, and patterns of behavior. Preventative interventions like digital therapeutics don’t require therapists or a care team, which significantly increases their capacity to focus on the people that need their help the most. They provide an answer to the shortage of care providers and offer ample opportunity to increase access to mental health.
Attitudinal barriers like stigma and low perceived need prevent many people around the world from seeking support. Mental illness is often associated with weakness or a lack of competence to deal with one’s own problems and emotions; therapy or treatment is seen as exclusively for those who are dealing with diagnosed mental conditions. Such misconceptions, often perpetuated by cultural belief systems, are harmful and hold people back from fully living life. Fortunately, mental wellness is slowly seeping into our collective consciousness. The mental health space is well on its way to normalizing the conversation and empowering everyone to see their mental health as something that requires continuous care and practice. Mental health is not only the absence of a mental disorder, it is also the experience of something positive i.e. a flourishing state of being — or flourishing mental wellness. Companies are increasingly embracing a workplace culture that values vulnerability and creates a safe space for employees to talk openly about mental health. Apps like Headspace and Calm are ubiquitous and employers are making subscriptions widely available to their employees.
Finally, the diversification of tech-enabled innovations has begun to shift the mindset that mental health is merely something in need of treatment, to a view of wellbeing that we can and should invest in preventatively, Smartphone apps are promoting mental wellness through mindfulness and meditation (e.g. Headspace, Calm), CBT-based interventions (e.g. Talkspace, Superbetter), mood induction (e.g. Happify, MoodKit), and flow states (e.g. Flow Lab). These Mental wellness apps are increasingly integrating functionalities to self-monitor progress and report on feelings, thoughts, or behaviors which present the unique opportunity to promote psychological growth and self-awareness, long before serious conditions develop. Evidence on the effectiveness of these apps is scarce but growing. Our hopes for the future are that there will be more market regulation and startups will conduct more rigorous research, providing consumers with adequate information to know which one to trust. Furthermore, we hope to see developers incorporate AI and machine learning into their applications. This way, large data sets can be generated and analyzed, providing valuable insights into the extent and timing of users’ mental health needs as well as patterns of behavior that tell something about their temporal state of health. For example, strong variations in sleep, physical exercise, social communication, or even how someone uses their smartphone can indicate signs of deteriorating or improving mental health.
Online mental health services, digital therapeutics, and the promotion of mental wellness through smartphone apps are just a few of the many innovative ways business is increasing access to mental health and wellness. At the same time, they’re changing the conversation to one in which everyone is empowered to think about their mental health and is given the tools to nurture better mental wellness.
Niels is Impact Researcher and Content Creator at Masawa. Having a background in both International Entrepreneurship and fine art photography, he continuously explores the intersection between art and social entrepreneurship.
