It’s time to make digital mental health a real option
Most people with mental health challenges don’t receive any help and even those who do fail to receive high-quality care as defined by a sufficient number of sessions of evidence-based care. Despite the promise of expanded access to mental health care through the Mental Health Parity and Addiction Equity Act (MHPAEA), significant disparities exist in use and reimbursement of mental health care compared to physical health care. We are never going to solve these problems through trained professionals alone, we need to expand the types of resources that are available to people in need.
Digital mental health could help. Digital mental health includes a variety of digital solutions ranging from self-guided apps that help people self-manage their own symptoms, to digital tools that support people engaged in traditional care, to virtual care platforms that allow people to access care in the comfort of their own homes and receive care that might not be available in their local region. All of these types of digital mental health tools have been found effective to varying degrees, with the most effective being those that involve some form of human support. But technology is not a panacea. Merely making digital mental health tools available will not solve all of our problems.
First, the number of digital mental health tools has increased to a dizzying degree. Some of these tools are based on evidence-based practices while others have actually been submitted to rigorous clinical evaluations. But too few digital mental health tools are evidence-based or science-backed. The majority are likely ineffective at best and harmful at worst. We need standards and regulations to help separate effective and safe digital mental health tools from those that are useless and harmful. We have been tackling this problem for the last decade at One Mind PsyberGuide and others have been working in this space too such as the American Psychiatric Association’s App Evaluation Model, the Defense Health Agency’s Connected Health Branch, and mindapps.org, but more work is necessary. This information needs to be standardized and widely available to consumers. It will likely take considerable investment in this space to ensure this and I think a public-private partnership will be necessary to ensure the coordination of the relevant stakeholders in this space.
Second, we need a model to pay for effective digital mental health tools. We have recently seen several large digital mental health companies face the financial reality of insufficient business models to back these tools. Although direct-to-consumer models and venture capital funding helped build this space, new models of funding will be needed to sustain it. Medicare and Medicaid reimbursement could create incentives to better build products to help those often underserved by traditional mental health services and provide digital mental health tools as a safety net to expand access to effective mental health services.
Lastly, we need to make sure digital mental health tools represent the diversity of those in need. This includes considering issues of race and ethnicity, age, and rurality. Following the motto of “nothing about us without us” we need to make sure that this diversity is represented in founders of digital mental health companies, in digital mental health researchers, and the populations involved in digital mental health research.
These are not easily solved problems, but they are solvable. We will only make progress if we decide that it’s truly time to make digital mental health an option. Other countries are already adopting digital mental health tools as frontline treatments for those in need of mental health support. It’s time to make digital mental health a real option for those with mental health needs in the United States. Let’s not only encourage people to share their mental health journeys, let’s work towards ensuring that when they reach out for help they can find effective, safe, and reliable mental health supports. Digital mental health tools can be a piece of that puzzle, but only if we address the challenges facing the field and support access while ensuring quality in digital mental health.