The challenge of developing digital solutions for mental health

From left, moderator John MacPhee leads a discussion of digital solutions for mental health with Virna Little, Andy Haim, Vindell Washington, and Patrice A. Harris. The discussion took place Nov. 16 at the HLTH Conference in Las Vegas. (Photo: Ron Southwick)

As America’s mental health crisis grows, more innovators are devising digital health solutions aimed at behavioral health.

But as a panel at the HLTH Conference noted last week, many of those solutions aren’t aimed at more serious mental illnesses.

Andy Haim oversees the treatment and preventive intervention research branch at the National Institutes of Mental Health, which focuses on developing solutions for treating mental illness. He acknowledged it’s much more difficult to get regulatory approval for software devices for mental illness.

“It’s much harder than finding a product that’s broadcast to the worried well,” Haim said.

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Patrice A. Harris, CEO and co-founder of eMed, a digital health company, and former president of the American Medical Association, said it’s time to have conversations with regulators to discuss ways to make it easier to get solutions to market.

Digital health entrepreneurs need to engage people working in the trenches throughout the entire development process, said Virna Little, co-founder and chief clinical officer of Concert Health. That component is critical, she said.

“Sometimes I think it’s not there,” Little said.

Vindell Washington, CEO of Onduo and chief clinical officer of Verily Health Platforms, said innovators must look to the mental health community to design a solution that isn’t just elegant but “is something that is changing lives.”

“It’s very easy to be overconfident in the design of solutions,” Washington said. Innovators need to have humility and must “understand you don’t know everything about that community.”

Harris pointed to another example of well-intentioned digital solutions that haven’t met expectations: electronic health records. She said the design of health records didn’t include doctors, and electronic health records have become a leading cause of burnout among physicians.

“The lesson learned is go to the end user. Go to the patient,” she said.

“We need to go to the community and say, ‘What do you need? What do you need, and help us develop it.’”

Undoubtedly, mental health needs are growing. During the COVID-19 pandemic, about four in 10 adults have reported anxiety or depressive disorder, up from about one in 10 adults before the pandemic, according to the Kaiser Family Foundation.

Suicide among young people is rising and is now the second leading cause of death among young people, according to the Centers for Disease Control and Prevention. The American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association have asked President Biden to declare a national emergency to combat the growing mental health crisis in America’s youth.

Harris pointed out that this is an unusual opportunity to develop new ways to deliver mental health services, with bipartisan interest on Capitol Hill and the attention of the C-suite. But she said many different systems are going to need to be part of the solution. She also called for greater federal investment in mental health.

The panel also discussed weaving behavioral health into primary care. Health groups, including the American Medical Association and the American Psychiatric Association, are pushing for the integration of mental health and primary care.

Little said primary care doctors typically aren’t thinking about how care differs for those with mental illness. She said she asked primary care physicians about how treatment for patients with diabetes is different if a patient is bipolar “and there was no answer.” It’s one thing for a doctor to talk to a diabetic patient about the importance of exercise, but someone with mental illness may not be able to get themselves out of the house to work out.

“There’s greater opportunities to engage primary care in doing better care or think about how they’re delivering care in this community,” Little said.

Haim noted the difficulty of engaging primary care physicians in research, with doctors commonly saying such studies are good but they are simply too busy.

“It’s going to take time to embed sticky solutions in primary care focused on mental health that are sustainable,” Haim said.

Harris cautioned against blaming primary care doctors, who are seeing a large volume of patients in 15-minute blocks. Panelists agreed, though, that primary care doctors need to be part of the broader solution of improving mental health.

When asked what the National Institute of Mental Health is seeking in applications for funding of digital solutions, Haim cited the importance of working with stakeholders in behavioral health.

Innovators need to have a clear idea of who is going to use their solutions, and how they will be implemented, such as how they integrate with electronic health records.

“We expect stakeholders are involved,” Haim said.

Ultimately, Haim said innovators must show that they solutions actually work in practice, and can be sustainable.