Over recent years, digital solutions have begun to transform mental healthcare. There are platforms that make connecting with clinicians easier, as for physical health, as well as software that directly provides users with tools to manage their mental health or offer educational resources. Pick up your phone and you can download an app that helps you put CBT techniques into practice, or one that supports recovery from an eating disorder. Just last week the UK’s National Institute for Health and Care Excellence conditionally recommended eight digitally enabled therapies to address depression and anxiety disorders, including PTSD and body dysmorphia.
Such innovation is crucial at a time when demand for help is high yet traditional support is often minimal. Lack of state funding is a large issue: the World Health Organisation reported that in 2020, global governments spent just 2% of their health budget on mental health. Then there’s the long-lasting impact of the pandemic on mental health as well as the toll of factors such as the cost of living crisis. According to research from the British Association for Counselling and Psychotherapy, two thirds of therapists say cost of living concerns are causing a decline in people’s mental health.
As a result, there’s a big appetite for digital mental health solutions. In its 2022 survey, The Organisation for the Review of Care and Health Apps (ORCHA) found that consumers aged 18-44 would choose digital health to support a mental health condition over and above prescription medication, such as an antidepressant. Technology that supports meditation and mindfulness, improving overall mental wellbeing, is also hugely popular. Last year, Calm (a mindfulness app) made TIME’s list of Most Influential Companies of 2022, boasting a £2 billion valuation and 4 million paid subscribers.
But there’s a problem with this progress. While certain mental health conditions are attracting attention, funding and digital solutions, others are being left behind. More complex or severe conditions, such as substance abuse, psychosis and paranoia, are not being given the same resources and focus as comparatively straightforward conditions. The crucial role digital health could play in supporting patients with complex mental health needs is not being fully realised and a duality is emerging in mental healthcare provision.
It’s a story we see played out more widely in society. Mental health conditions, such as anxiety and depression, have gained a level of social acceptance and shed some of their stigma, and there’s greater discussion of these experiences and their impact. Yet this understanding does not seem to extend to conditions like schizophrenia, bipolar disorder and personality disorders. When illness starts to look too complex or ‘difficult’, or when it stops someone functioning in the way we expect, we turn away. The message seems to be that it’s ok to have a mental illness – just as long as you act like you don’t.
Stigma may play a part in uneven tech provision but there are other factors too. Complex mental health conditions require more complex tools, which are harder to create than those for more easily treatable conditions. When setting out to build digital solutions, it’s simpler to go for the ‘lower hanging fruit’ of designing more straightforward tools and therefore this is the path more commonly chosen, leading to patients with complex health needs being ignored.
It’s vital we end this avoidance. Patients with complex and severe mental health conditions are in urgent need of support and can face higher mortality rates: for example, schizophrenia is associated with one of the highest mortality risks of all psychiatric disorders. Collectively ignoring this need is, at best, doing these patients a disservice – at worst, actively discriminating against them.
This isn’t to detract from the solutions that are already being created to help those with complex mental health needs. We just need more of them, and more resourcing and attention for this underserviced area. For instance, eMoods is a mood tracking app that can help support patients with bipolar disorder and I Am Sober allows users to track their sobriety progress as well as connect to a community for support. At Avegen Health, we’re currently working with experts from King’s College London to develop and trial an app for patients who experience psychosis. This app will give patients the tools they need to overcome paranoid thoughts.
The pace of digital innovation within mental healthcare is exciting but we also must be careful. As new tools are developed, the sector risks punishing patients with more complex and severe conditions by sidelining their needs in favour of building simpler health solutions. Failing to support them is both a missed opportunity to improve health outcomes and a social statement. But is it the statement that healthcare wants to make?
By Dr Nayan Kalnad, medical doctor and co-founder of healthtech platform Avegen Health