Medical technologies are not limited to remote examinations, robotic surgical controllers and diagnostic algorithms. Today they transform mental health domain, specifically, work methods with patients and the doctor’s role.
Mental health topic is hot as ever
The problem of mental health is not new, however, its specifics and the comparative study novelty, it lacks attention. People around the world are better aware of “traditional” diseases and, even if they can be easily treated, they still raise more concerns. Society stigmatizes mental diseases.
According to World Health Organization report, every fourth person globally is exposed to psychological and mental issues at least once in a lifetime.
About 900 million people are suffering from mental diseases today, and two-thirds make no attempts to seek qualified help. On average, there are 9 mental health professionals per 100,000 people in the world. In developing countries this indicator is less than 1, while in developed countries it sometimes surpasses 72.
The United States is the most studied market in terms of mental health. And this same country was the closest to technological breakthroughs in treatment area. According to the National Institute of Mental Health report, one in five adult Americans (or 46.6 million people) suffers from all sorts of psychological and mental illnesses.
Who got the worst of it? Millennials and buzzers. Among young people aged 18–25 years, one in four or 25.8% have mental problems. People over 50 years old suffer least of all (13.8%). Overall, out of 46.6 million patients, only 42% sought any medical help.
This is more than a medical problem. In the capitalist States, researchers have studied the impact mental problems have on the market. US economy loses $51 billion due to declining workforce productivity. Major mental illnesses (those complicating the fulfillment of key life and social functions) bring another $193.2 billion of lost profits per year to the economy. And in the UK, due to psychological and psychological issues, people take about 70 million additional sick days each year.
The total losses from mental problems for the global economy in the next 20 years may exceed $16 trillion. This is much more than the "price" of any non-infectious disease.
The scale of the situation resembles an epidemic. However, in the US, the solution to it is not treatment, but an interest surge in sedatives. The king of this market is Xanax. More specifically, a class of drugs called benzodiazepines on the basis of the active substance alprazolam. They briefly suppress anxiety and relieve fatigue.
The number of Xanax prescriptions increased by 67% between 1996 and 2013, the consumption tripled by 2016. Xanax is now regularly taken by up to 5% of all adult Americans. The drug has low tolerance, and together with opioid drugs, it becomes deadly dangerous. As a result, there’s been an eight-fold increase in deaths from benzodiazepines overdose between 1999 and 2015.
Technologies offer another perspective.
Apps and far beyond
Tech is not about digital hygiene or self-restraint. The treatment of mental problems from anxiety to clinical depression or bipolar disorder always rests on resources. Therapy is inaccessible to many, and even more scary because of stigma. But even short-term sessions with a specialist, are often not enough due to the nature of the disease.
Mobile applications can turn things around. Startups, academic institutes, research labs are developing programs that use active patient data collection to diagnose the condition in real-time. These applications capture dangerous patterns and stabilize the patient through short-term interventions.
- CrossCheck is a solution brought by Dartmouth Psychiatric Research Center. This is a scientific program for the treatment of schizophrenia, that had been tested over a year. The smartphone analyzes user behavior (launched applications, calls, SMS) and uses sensors (camera, GPS, microphone, accelerometer). The user should regularly report by answering 10 questions about own condition. The data is sent to the server for analysis and further issuing of a clear medical report. Collected data allows for timely response to behavioral changes, and sometimes even prevention of suicidal attempts.
- Companion is an application from a Boston-based Cogito startup that helps identify potential mental issues: from social isolation to anxiety or psychological trauma. This program went through trial by combat: during testing in 2013, about 100 of its users ended up in the Boston attack area. The team was able to accurately record the increase of symptom fixation. Companion does not make a diagnosis on its own. Having doctor’s diagnosis, the app can notify of the threat of relapse, as stated by MIT.
- Mindstrong is a California-based company founded by the former head of the Mental Health Institute. The application of the same name works on the “digital siren” principle. The app and an alternative keyboard are installed on smartphones to monitor all patient’s activity. The focus is on borderline personality disorder. Patients are impulsive, they have anxiety and poor self-control. They are not aware of a stressful situation happening.
- 7 Cups is also a Californian project that creates a network for quick patient care. The project employs and trains special operators for patient counseling. Today, there are 340,000 operators in 198 countries. If the situation is really serious, the patient is connected to a certified therapist. 90% of users feel better after an in-app session.
Software developers are not the only ones to occupy mental health niche. The deep tech domain (technological products based on scientific research) is far more wider. For example, the London-based Compass Pathways company intends to become the world's first medical psilocybin provider and treat depression, anxiety and other conditions.
According to Bloomberg, the idea is simple enough. Our brain, like any complex software, accumulates bugs over time due to incorrect blocks of code (in our case, individual neural connections). Substances such as psilocybin, taken in the right doses and under supervision, allows for brain reload. Where psychotherapy or serotonin stimulants fall short in battle with depression, this is a chance of survival.
The project was founded by a graduate of the St. Petersburg Medical Academy Ekaterina Malevskaya and her husband George Goldsmith. The company has already raised $58 million investment and received permission from US regulators to conduct full-fledged clinical trials. If the tests are successful, the products may be approved for official medical use.
To whom it may concern
Mental health is highly relevant for mobile developers. According to The New York Times, about 10,000 applications operate in the niche. But the majority of them does not rely on a serious scientific base, but rather streamlined wording about awareness and psychological peace. This drew attention of the University of Liverpool academics.
Scientists examined the list of apps the National Health Service of England recommends for depression. Only 4 of them provide comparatively reliable evidence of effectiveness, and only 2 actually meet scientific standards. The utility of the remaining 85% of apps cannot be proved. They mainly rely on mindfulness practices: breathing exercises and meditation which is not yet considered a clinically proven and effective treatment for depression or anxiety. It might help to cope with symptoms, but not more than that.
Real scientific developments are more complex: CrossCheck has not yet completed the testing phase, Companion has been in it for 5 years. In turn, Mindstrong and 7 Cups work directly with the Californian authorities in a five-year program, which has received over $100-million funding, and endures ongoing medical and financial audits. Regulators led by the mighty FDA (US Food and Drug Administration) do not just confirm the “clinically effective” status. Especially when it comes to personal electronics.
Progress is inevitable. According to insiders in the US medical field, the FDA is preparing to announce that applications will soon become part of medical protocols for determining mental illness. Recently, FDA launched Digital Health Innovation Action Plan providing regulatory framework for app developers. World Health Organization as well as UK National Institute for Health and Care Excellence issued their guidelines on digital health technologies. Simply put, they will move from extravagant tests to reality. Simplifying mental assistance can save lives.
There is a problem, there is a market. According to CB Insights, an estimated $89 billion is spent on mental health treatment in the United States annually. This, for example, is almost twice as much as the cost pregnancy and childbirth, even considering that over 50% do not turn for help.
Investments are ballooning. During 2013–2017, about $0.6 billion was invested in mental health industry. In the second quarter of 2019 alone, the investment amount reached $321 million. A ‘boom in VC funding’, as being put by Pitchbook.
Startups in this field have visited Y Combinator, Techstars and other accelerators. Investors fall for a clear and healthy business model. For example, the Talkspace application allows users to chat for $32 per week, and for $99 per week to have a video chat with therapists. SoftBank was among those who supported the project in $28 million round. Ginger.io project with similar functionality, but a more personalized approach, provides access for $129 — $350 per month. The project raised $28 million.
Health and digital medicine are one of the hottest niches where you can hear the battle cry of tech giants like Apple and Google. Mental health, which is starting to be taken more seriously, looks like a particularly understandable and profitable area. There is proven potential for the use of smartphones, AI, digital communication. FDA approval will make things completely clear. Hundreds of millions of people will have a chance for therapy or even recovery. Smartphones will no longer be source of problems, but become their solution.
To sum up, in the foreseeable future, we should expect the following trends:
- The boom of preventive measures where technologies will play a pivotal role.
- The diagnosis apps will work on the basis of scientific developments, and dataset will substantially boost their accuracy.
- A vast array of apps will be prescribed to patients ranging from VR applications for PTSD to games for treating depression.
- The prominent market players will increasingly partner with insurance companies.
- The new regulation is likely to come after the presidential elections. Warren, Murray and Smith, US senators, have been dealing with the PreCert program, aiming to reinvent medical services regulation by shifting the focus from products to developers.
- Much effort will be made to address data privacy issue and ensure due protection of sensitive information.
- Since the retention rates in mental health leave much to be desired, mental health applications will extensively rely on peer support techniques, which eventually will become a success factor and an enabler for gaining an upper hand.
Yuri Filipchuk, partner at CYFRD investment firm, explains what this means for investors, entrepreneurs and all of us.