the NEED for innovation in MENTAL HEALTH
and what we’d love to invest in
SEPTEMBER 2022
by Caterina Calisti & Federico Aureli
mental health includes our psychological, social, and emotional well-being.
It enables the individual to cope with the stresses of daily life, perform well, and build relationships. It is a basic human right. Hence why mental health disorders are one of the heaviest burdens of our society. The most common illnesses are depression, anxiety, bipolar disorder, schizophrenia, substance abuse, post-traumatic stress disorder, eating disorders, and dementia.
These disorders are more or less prevalent at different stages of life. Also, they are triggered by different factors based on the age group. No age group is immune. According to the WHO, 20% of children and adolescents around the world suffer from a mental health condition. Exposure to adversity, pressure to conform with peers, exploration of identity, quality of home life, and discrimination or exclusion are some of the important determinants of the risk of mental health conditions in adolescents. More than 20% of adults over 60 years old suffer from a mental and neurological disorder, the most common ones being dementia and depression. These conditions are often triggered by loss in capacity, chronic pain, or reduced mobility and can result in loneliness and psychological distress.
costs for the person and for society are dramatic
The cost of these diseases on the life of people affected by them is difficult to compute. Consider just that suicide is the leading cause of death in the age range between 15 and 29 years old.
Still complex, yet somewhat easier to measure, is the cost on society. Mental health conditions affect the wellbeing of the person, and thus also his/her ability to work, with frequent workplace absenteeism and loss in productivity as consequences. Thus, mental health is not only crucial for the individual, but also for the community and the socio-economic development of the country. It is estimated that depression and anxiety cost the global economy US$1 trillion each year.
Despite the high incidence of mental health disorders and the dramatic consequences they have on people’s lives and society, there is a huge gap between the demand for care and its availability: effective treatment coverage is low. One study conducted in the US found that 62% of adults live with mental illnesses, but only 41% with serious conditions have received any form of mental care in the past year. Depending on the geographical region, shortages of mental health services are more or less common: for example, 55% of counties in the US have no psychiatrists, psychologists, or social workers.
Limited access to care is not the only issue. Other types of barriers such as fear related to the social stigma associated with mental disorders and the cost of the treatments, in addition to privacy and time constraints also play a role. But this is changing, with more awareness being raised around the topic of mental health.
“For the longest time, I thought asking for help was a sign of weakness because that’s kind of what society teaches us. That’s especially true from an athlete’s perspective. If we ask for help, then we’re not this big macho athlete that people can look up to. Well, you know what? If someone wants to call me weak for asking for help, that’s their problem. Because I’m saving my own life.” –Michael Phelps
Mental health has been one of the hot topics of the past decades, with celebrities and athletes opening up publicly about their mental health struggles. Conversations about self-care, meditation, journaling, and other strategies to fight stress have been all over social media. The Covid pandemic has accelerated the process of de-stigmatization of mental health: social isolation exacerbated mental disorders such as stress, depression, and anxiety, strengthening, even more, the need for mental health care.
can digital therapy services fill the treatment gap?
The entire process of public education about mental health and ultimately the pandemic created a fertile ground for the birth of digital mental health services, which aimed to expand the accessibility of mental health care and to reduce even more the stigma associated with it. In the past few years, there has been a boom in digital therapy services, resulting in as many as 20000 mental health apps existing today, with Calm or Headspace being two of the most popular ones.
It is worth mentioning that the engagement rates of these two titans have dropped significantly in the last year. Calm recently announced a 20% layoff. One of the reasons for the drop in engagement is that people have less time to devote to apps now that “regular” life has resumed and they are rarely at home.
We at Nina Capital have screened over 4000 companies in the last three years. Of these, 4.4% are focused on mental health. Technology-wise, the majority of these companies (57%) are mobile apps, 16.6% offer telemedicine solutions, 13.7% are pure algorithms and 8.6% are in the virtual reality space.
Most innovations we evaluated come out from the United Kingdom (22.8%) and the United States (22.2%), followed by Germany (11.4%), Spain (8%), and Denmark (4%).
Examples of services we have come across in the past years include patient profiling apps to find the best match between patients and therapists, therapy modules and coaching bots for behavioral dysfunction, and telemedicine apps providing video or text online therapy with psychologists 24/7.
Wellness apps, however, were definitely among the most frequent types of services, often claiming a holistic approach focused on multiple pillars of an individual’s health such as nutrition, physical activity, and stress control.
The abundance is welcome: there’s definitely a need for innovation in the space. However, it does pose a challenge for entrepreneurs that are looking to raise capital. So, if you are out raising and interested in working with us, we thought we’d give you some tips on how to grab our attention.
First of all, we look for good science and good evidence.
Second, we look for outliers targeting specific populations or diseases that we believe are undeservedly unmet given today’s very high number of players in the mental health market.
This post is not about good science and good evidence. This post is about the latter — the areas of need often neglected by digital therapy services, in which we would like to invest.
unmet area of needs #1: specific underserved populations
As mentioned before, patients in different age groups are subject to suffering from very different mental health diseases. The needs of a population, however, are not only influenced by the stage of life: profession or comorbid diseases can have a great impact on the psychological well-being of a person as well.
We believe that populations most in need of focused mental health innovation and services are:
Athletes: According to the American College of Sports Medicine, 35% of elite athletes struggle with eating disorders, burnout, depression, or anxiety. Most of these disorders are triggered by continuous exposure to very competitive environments, where athletes are expected to meet extreme requirements, perform under pressure, and thrive towards perfectionism. In the past decades, athletes would rather not open up about their mental struggles for fear of losing scholarships, disappointing others, or being judged due to the stigma associated with mental conditions in sport. Thankfully, this reality is slowly changing and world champions are raising awareness about their own challenges: one of the most impactful recent events is world champion gymnast Simone Biles stepping off the stage during the Olympic games in 2020 to preserve her mental and physical health. Even though these iconic gestures help convey the message that mental health struggles are not signs of weakness, there is still a lot that could be done to help athletes cope with their extreme lifestyles by encouraging and suggesting healthy routine plans in terms of sleep, nutrition, and social interactions.
Students: According to the National Alliance on Mental Illness (NAMI), 75% of students experience some sort of mental health struggle during college and almost half of college-aged individuals had a psychiatric disorder in the past year.
Most of these issues originate from the inability of the student to cope with the intense workload and pressure to succeed. As a result, students may feel overwhelmed and anxious, which in turn has a negative impact both on their health routines, potentially leading to eating disorders, and on their performance, increasing the chances of dropping out of school. Other frequent experienced feelings include depression, uncertainty about the future, and suicidal thoughts. Despite these huge numbers, only 6–15% of college students seek mental health treatments. This may be explained by stigma and financial, accessibility and time restrictions. There is a strong need for mental health services that can circumvent these barriers.
Patients with chronic illnesses: Chronic diseases are defined as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living. In patients with chronic diseases, the prevalence of Major Depressive Disorders (MDD) can reach up to 20–40%. When a patient is diagnosed with a chronic illness, few tools are offered by healthcare professionals in order to tackle the mental health issues that can arise in such patients. Yet, having issues such as denial or depression in these patients can lead to lack of awareness, poor self-care, decreased mobility and increased mortality. Startups in this field could launch evidence-based personalized disease-specific programs, including patient self-education on their illnesses, psychotherapists consultations, diaries and stress-relief activities, and patient support networks.
unmet area of needs #2: serious mental illnesses
“The availability of urgently needed treatment in serious mental illnesses is completely inadequate.We don’t have a recovery based system, we have a sick-care system, crisis focus: we wait for people to get into crisis, put them through the most intensive, expensive care we can, and then we churn them out again, until they have another crisis. There is no continuity, no sense of comprehensive care. There is a space for companies to meet these needs.” Thomas Insel, MD, fmr. director of NIMH. Speech at Aspen Health 2022
Serious mental illness (SMI) is a diagnosis that includes psychotic disorders, bipolar disorder, and either major depression with psychotic symptoms or treatment-resistant depression. If the level of functional impairment is severe, SMI may also include anxiety disorders, eating disorders, and personality disorders. In 2020, there were an estimated 14.2 million adults in the United States with SMI. This number represented 5.6% of all U.S. adults.
Read more at: https://mentalillnesspolicy.org/serious-mental-illness-not/
According to the National Institute of Mental Health, over a one-year research period, 40% of individuals with schizophrenia and 51% of adults with bipolar illness in the U.S. went untreated.
The main barriers in order to overcome this worldwide epidemic mainly rely on lack of services and funding: a 2020 study from the US government stated that in order to offer evidence-based mental health care in the US, an additional 4 million trained professionals would be needed.
Major Depression and Bipolar Disorders: major depressive disorders and bipolar disorders are characterized by mood and behavior fluctuations over time. A service that can continuously monitor these symptoms could add substantial value to care management.
Early identification of manic or depressive episodes would allow both the patient and the psychiatrist to set preventive measures and/or treatment modifications.
In the framework of precision psychiatry, continuous patient monitoring and data analysis (perhaps in combination with machine learning models) might improve relapse prediction and the deployment of smartphone-based therapies in real-time.
Psychosis/schizophrenia: Among people living with schizophrenia, research consistently demonstrates very low adherence to antipsychotic medication. Recent studies, for example, have shown nonadherence rates between 26.5% and 58.8% in this population. Many patients struggle with motivation, insufficient support, and diagnosis denial.
Digital platforms engaging patients in therapy compliance could add great value in the care of schizophrenia, ranging from simple medication reminders to psychoeducation and creating awareness about the disease.
Furthermore, through the use of remote monitoring platform technology, real-time patient-generated symptom data have the potential to support the scheduling of medical appointments based on need, improve treatment decisions by giving a clearer picture of changing symptom patterns, and timely alert clinicians about the need for intervention.
our call to action
Despite the explosion of mental health startups, we still think there are pain points to be addressed in the space. If you are a founder working on building something unique for:
- Specific underserved populations
- Severe mental illnesses such as schizophrenia and mood disorders
please reach out to us at Nina Capital. We are looking forward to meeting you!
Caterina & Federico
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