The lack of mental health parity in care delivery has been spoken of several times before, but probably little has been done globally to treat this serious cause of disability. While the system has relied on inadequate infrastructure, resources, and qualified personnel in the past, the digital health revolution has begun to make alternatives available to solve such challenges. Frost & Sullivan’s new analysis, Future of Behavioral Healthcare Paradigms, Forecast to 2022, throws light on the growing importance of behavioral healthcare, and several new avenues now becoming available to provide suitable care to those in need.
Why Behavioral Health Is More Important Now than Ever
Global prevalence of mental disorders is a whopping 29%; and coupled with substance abuse disorders, this category forms the number 1 cause of disability globally. As per World Health Organization (WHO) estimates, musculoskeletal disorders form the second highest cause of disability, but trail behind the top cause (mental and neurological diseases) by 129%! The economic impact of behavioral health illnesses is a whopping $16.3 trillion! That is the estimated global cumulative economic output loss attributed to behavioral health disorders between 2011 and 2030.
Despite these statistics, it is well-known that behavioral healthcare delivery lacks in several aspects, falling significantly short of the need. Almost 45% of the world’s population lives in about 60 countries which have less than 1 psychiatrist per 100,000 people, and only 1% of the total global healthcare workforce can deal with behavioral health issues. The cumulative effect is that a large number of those suffering from behavioral health issues go undiagnosed. For example, in 2004, 56.3% of depression patients, 50.2% with bipolar disorder and 32.2% of schizophrenia sufferers were undiagnosed, according to the WHO assessments. This is where the opportunity for stakeholders lies, with the advent of digital technology solutions to support them.
Upcoming Digital Solutions for Behavioral Health Support
While several digital solutions exist, a few randomly selected examples are highlighted below.
Personalized Treatment
Iodine, Inc.’s Start smartphone app designed for depression patients and serves as a pill reminder, mood tracker, and side-effect manager, while tracking progress with depression tests. With every medication, patients can take the depression test and record side-effects, to track their progress over time. Results can be shared with the provider to aid in the search for the most effective anti-depressant for the patient.
Medication Adherence
Otsuka Pharmaceuticals collaborated with Proteus Digital Health to design the first digital pill for behavioral health. The US FDA accepted a new drug application called Abilify, a drug for treating schizophrenia, bipolar disorders, and some depression patients, that incorporated ingestible sensor technology. Once ingested by patient, stomach acids will activate a power source, sending a signal to a sensor electrode worn on the patient’s skin. The sensor will wirelessly communicate information such as vitals, body position and verification of medication ingestion to a smartphone app. The information can be shared with the provider, who can verify adherence to medication.
Neuromodulation Devices
Nervana is a novel music player that employs transcutaneous vagus nerve stimulation for mood enhancement. With dual-jack headphones, the player generates electric signals, synchronized with the music. The left earbud plays music, and also passes electric stimulation to the vagus nerve through the inner ear.
Thync is another mood-altering device that helps generate good vibes. Worn on the forehead above the eye brows and targeting facial and neck nerves, the device provides electric stimulation to generate one of 13 ‘vibes’ or states (such as work, bliss, unwind, and awake), controlled by a Bluetooth connected smartphone app, providing on-demand control of moods.
Wearables
Emotiv Insight is a wireless electro-encephalogram (EEG) device that can be worn during daily activities to record brainwaves. These are then translated into data for the user to better understand their brains and mental states, and leverage the data to optimize their cognitive performance.
Another interesting device, although a misfit in the category of wearables, is the ‘Hello’. An environment tracker, the spheroid device tracks temperature, light, and air quality and a sleep-movement tracker (which clips to user’s pillow) to provide information on best sleep conditions.
Virtual Reality
Virtual reality solutions help in providing exposure therapy for disorders such as phobias and psychosis, or in providing ambient environments for meditation and relaxation. CleVR, is one such company that exposure therapy products for phobias (heights and flying), as well as for psychosis and social phobias (interactions with strangers). RelaxVR provides guided meditations with melodious, ambient music to accompany the visual and meditative experiences, visuals are of several locations around the world. An interesting approach is employed by Mimerse, which focuses on arachnophobia (the fear of spiders, with a virtual therapist helping users in real-time undergo exposure therapy played as a game (Itsy).
Other Emerging Approaches
Gamification and artificial intelligence are also gradually percolating in to the behavioral healthcare space. Akili Interactive Labs uses a gamification approach to diagnostics, assessments and cognitive therapeutics for mental disorders such as ADHD. Tess is a psychological artificially intelligent therapist (if it may so be called) that administers personalized psychotherapy via channels such as SMS, Facebook Messenger, Web browsers, or other such platforms.
Why Should Healthcare Stakeholders Pay Attention?
Opportunities abound – $2.5 trillion was the annual global spending on behavioral health illnesses in 2010; in contrast that with the global spend on healthcare in 2009, which was approximately $5.1 trillion. Moreover, this expenditure on behavioral health illnesses is set to increase to $6 trillion by 2030, indicating a large growing opportunity!
It is now being realized and accepted that behavioral health disorders play a role in the management and treatment of physical disorders. For example, patients with chronic diseases such as diabetes have a higher chance of being depressed – a recently diagnosed patient may be anxious about a lifetime of managing a complex disease or a chronic patient may feel depressed about seeing no cure, or an end to disease management. The stress of managing a complex disease may also result in spikes in blood sugar, or induce a person to turn to seek recourse in sweets. Consequently, even if diabetes drugs and insulin are doing their job, the mental state of a person may result in poor management of the disease, leading to further exacerbation of the situation – a vicious cycle.
The idea that physical health and mental health are closely interconnected is not too far-fetched. In fact, studies report that more than 30% patients suffering from colorectal cancer or coronary heart disease are prone to depression. Inversely, depressed patients are at a 1.6 times higher risk to develop diabetes or heart disease in their lifetime. While current treatment paradigms address only physical health conditions, addressing both dimensions of the patient wellbeing effectively, that is physical and mental, will help rein rising healthcare costs.
Conclusion
In an era of value-based care and outcomes-based reimbursement, treating a patient might soon necessitate employing holistic approaches, ones that involve physical as well as behavioral health professionals working in tandem. For example, MindCare Solutions employs this approach, leveraging a telehealth backbone, where patients receive holistic treatment after consultation between physician, behavioral health services professionals, (therapist/counselor) and nurse or social worker.
Upcoming digital solutions are best suited to overcome the traditional challenges of inadequate infrastructure and cultural stigma that afflict the behavioral healthcare delivery space, and can provide additional revenue streams for the incumbent stakeholders of the healthcare industry.
