Digital tools revolutionize mental health care in the United States

summary

The United States has long suffered from a severe shortage of mental health services. The pandemic has brought to light the effectiveness and wide availability of digital and virtual mental health care and in so doing, may have thrown a lifeline to our mental health system.

We have a mental health care crisis in the United States. Sixty percent of youth with major depression received no mental health treatment in 2017-18, and a quarter of adults with mental illness reported an unmet need for treatment. In the United States, 55% of counties do not have a psychiatrist, psychologist or social worker, and 70% do not have a single child psychiatrist. Queues for addiction care can last for weeks; 70% of those who needed drug treatment in 2017 did not receive it. To make matters worse, many practices have shut down or reduced their capacity in response to pandemic health issues.

Insight Center

Due to the pandemic, virtual care and other digital tools are more important than ever to support existing care, provide scale and increase capacity. Clinician-based virtual care is replacing traditional in-person office visits with synchronous video or audio visits or asynchronous text messaging. This provides alternatives to the traditional 50-minute therapy hour and allows for a better match between supply and demand across times of day and geographic areas. Asynchronous messaging, for example, allows patients to text a clinician or coach anytime and get a response later.

Non-clinician digital mental health services, such as chatbots, videos and written content, playful user exercises, and digital cognitive behavioral therapy (CBT) programs, are a good adjunct to clinician-based virtual care. , allowing 24/7 access for those with less intensive needs.

Increasingly, innovative mental health providers are combining digital tools and virtual care to create a robust ecosystem for end-to-end patient care, including referring patients to in-person care when needed. This combination of tools provides the mental health care system with scalable solutions and increased flexibility while improving access and convenience for consumers. Because of these benefits, the majority of employer sponsored health plans now offer virtual and digital options for mental health care.

Efficiency

How well are digital services and virtual care working? A 2016 metanalysis of 452 telepsychiatry studies found high patient satisfaction and equivalent quality of in-person care. And a 2020 Veterans Administration study found that video telepsychotherapy was as effective as in-person office care in treating depression and post-traumatic stress disorder. Overall, most published studies show that mental health care over the phone is as effective as in-person care in treating depression, anxiety, and obsessive-compulsive disorder.

Similar results have been generated by digital tools that provide animated and / or human video instructions, content libraries, and exercises. Digital CBT programs have been shown to be as effective as face-to-face CBT in treating anxiety, depression and insomnia. A randomized, placebo-controlled trial of CBT online for insomnia demonstrated improvements in sleep quality and wakefulness. This technology, marketed today under the name Sleepio, has been implemented by many large employers. A chatbot developed by Woebot that provides support for CBT, DBT (Dialectical Behavior Therapy) and mindfulness has led to significant improvement in anxiety and depression in young adults in randomized clinical trials. And meQuilibrium, a stress and resilience app and program now available to many employers, has shown a significant positive dose-response effect on stress and associated symptoms in those enrolled in a digitally administered resilience program.

Each of these types of healthcare solutions can be delivered in a HIPAA compliant manner with appropriate privacy protections.

Scalability and Access

Ginger is an on-demand support program that guides users to address low-acuity mental health care needs, such as mild depression or anxiety, through secure asynchronous texting with trained coaches supervised by therapists and supported by artificial intelligence. (Many virtual care platforms use algorithms to match users to providers; there is evidence that this can increase patient satisfaction and even clinical effectiveness.) With Ginger, patients are referred to a therapist. or a doctor if they ask, or if the AI ​​or coach recognizes the need for escalation. Coaches focus on needs including stress management, goal achievement, and recovery from a loss using tools such as motivational interviews and app-delivered content. By directly treating less acute problems and classifying people to therapists or physicians as needed, the program offers scalable and cost-effective support. Ginger is offered directly by many employers, is networked with several health plans and counts Cigna and Kaiser Permanente among its investors. Providers, including Spring Health, Lyra, and Modern Health, also provide a continuum of care from addressing low-acuity needs to triage users to more advanced care.

Talkspace, a platform with over one million users, is also evolving access by connecting users to licensed providers. Members or employers pay a subscription fee for unlimited 24/7 access to therapists via text, voicemail and / or video in their secure app. Members or employees can also schedule video or phone sessions with a therapist as needed. While traditional 50-minute sessions are available, most of the care is delivered in small bites, allowing therapists to care for more patients and have more flexible schedules.

In addition to the planning flexibility and therapy efficiency that these platforms offer to both patients and providers, these digital solutions have the potential to reduce practitioner overheads. (They don’t need to have an office.) They also greatly expand access at potentially lower cost to patients and employers than the cost of providing traditional in-person care to the same population.

The way to go

The Covid-19 pandemic has led to a dramatic increase in the use of virtual and digital mental health services. The pandemic and associated lockdowns have left more patients in need with no choice but to walk away from in-person care. Clinicians who had resisted virtual visits faced a devastating loss of income and also moved online. However, sustaining and building on the gains in access to care will be essential. Many users and clinicians have had good experiences with digital tools and virtual care, and their availability and use can help us meet our mental health needs as the pandemic recedes.

Obviously, virtual and digital care is not for everyone and is inappropriate in some cases, for example in most emergency situations. But virtual and digital care can improve accessibility and provide essential additional access to those who need it. In a study on virtual care, Accenture reported that 46% of patients “would choose to receive mental health appointments virtually.” Gen Zers (born in 1997 or later) were more than four times more likely than baby boomers to prefer virtual care to in-person care. Additionally, some communities that have historically faced stigma and discrimination may prefer virtual or digital care.

The pandemic has shed light on the value of digital and virtual mental health care, and in doing so, may have thrown a lifeline to our mental health system. If we can leverage the lessons of the pandemic to drive increased and appropriate use of digital tools and virtual care, we can dramatically improve long-standing issues related to inadequate access to mental health services. Crucially, digital tools and virtual care will allow us to effectively meet the mental health needs of more Americans than ever before.