The recent annual World Mental Health day (which took place on the 10th October) put the spotlight back on mental health, behavioural problems and wellbeing. According to Our World in Data, in 2017 around 970 million people worldwide had suffered a mental or substance use disorder. The WHO estimates that the economic cost of anxiety and depression, which are the leading mental health disorders, cost around US$ 1 trillion per year alone. However, healthcare services for mental health have been chronically underfunded, which has led to a huge care gap. In addition, a large proportion of people are hesitant to seek help from a professional for their mental health challenges.
In our previous 2018 article series about mental health in emerging markets, we explored the situation across APAC, LATAM and MENA and discussed some of the root causes of mental health in these regions, the impact and potential solutions.
The Covid-19 pandemic has dramatically accelerated the mental health crisis. Many people’s mental health deteriorated due to financial uncertainty, social isolation, fear of infection, or lack of access to physical exercise and healthcare services. Data from the OECD shows how the prevalence of anxiety increased significantly in 2020.
National estimates of prevalence of anxiety or symptoms of anxiety in early 2020¹ and in a year prior to 2020
Consequences of the pandemic – a rise in mental health awareness
A survey conducted by the World Health Organisation amongst 130 countries between June – August 2020 highlighted how the pandemic heavily disrupted access to traditional mental health-related services such as in-person counselling, therapy, or medication.
However, many countries have seized the opportunity to talk more openly about and de-stigmatise mental health at the workplace and throughout the wider population. In China for example, the government’s response to the mental health crisis during the pandemic was to establish hotlines to give the public remote access to counselling and psychological services. Social media platforms such as WeChat and Webo were utilised to disseminate guidelines and educational programs for self-managing mental challenges.
According to a study by Willis Towers and Watson, across APAC, in 2020 around 40% of companies were looking to expand their wellbeing programmes to help tackle mental health issues, with benefits such as employee assistance programmes, mental e-health services and access to wellbeing apps offering support.
E-mental health solutions are on the rise
In our mental health article series, we pointed out that beyond-the-pill strategies are useful to complement medical treatments. In particular, mobile and digital-based initiatives seemed promising in regions where access to in-person mental health services varied.
The pandemic has further led to the emergence of digital and virtual mental health services as an alternative to traditional in-person services. The behavioural health software market is expected to reach US$ 4.9 billion by 2026 and telemental health, telepsychology or telepsychiatry services have seen increased demand during the pandemic when access to in-person services were essentially unattainable.
There are a number of benefits associated with virtual mental health services. They are often accessible at any time (24/7) from anywhere and could be a huge opportunity to close the existing care gap. For example, in a country like Singapore where there are only 4.1 psychiatrists per 100,000 people (WHO, 2017) virtual care offers broader access to more people.
The threshold to access virtual mental care might also be lower for many sufferers given the anonymity of many services, the convenience of receiving care in their own homes and potential lower costs. For many people who were sceptical about using mental health services, digital offerings are a good way to be introduced to care, and also empower individuals to help themselves. Finally, many mental e-health services collect valuable data that could support ongoing management and conversations with healthcare professionals.
E-mental health services
Calm and Headspace are the most popular self-guidance apps using principles of mindfulness. These apps, and many others like them, teach guided meditation, relaxation, and offer sleep stories or breathing exercises to help the individual achieve wellbeing. They are often recommended by PCPs or mental health service providers as an aid to relieving anxiety.
Many apps not only provide tools for self-management but will also connect the user to a specialist. As with telemedicine for physical conditions, telepsychotherapy and counselling have started to penetrate the market during the pandemic. In Indonesia, patients can receive virtual counselling from a psychologist on Save Yourself; in Thailand, Ooca provides video sessions with a therapist, and in Vietnam, the platform Mosia offers a safe space where people with mental health challenges can share their thoughts and emotions but also find a counsellor to talk to.
Woebot takes a slightly different approach: the app uses a chatbot, referred to as the ‘relational agent’, which was developed based on artificial intelligence and natural language processing (NLP) techniques. This agent mimics human interaction and develops a relationship with the user to support them through their mental health challenges. According to an observational study by Woebot their relational agent is as effective in creating a bond with patients as a human therapist.
Yet another angle of mental health apps is the use of gamification in particular to target a younger population. SuperBetter for example, aims to increase resilience and improve mental wellbeing through their science backed Live Gamefully® method. Another digital therapeutic mobile game is Champions of the Shengo, which not only incorporates gamification, but also comes with a data hub and a heart rate sensor to monitor and provide biofeedback. They want to empower young people to self-manage stress, anxiety and frustration through emotional self-regulation.
Wearable solutions such as Fitbit and other trackers have become more commonplace in recent years, so it is no surprise that digital mental health solutions have utilised this popularity. One example is the digital therapeutic Feel by Sentio Solutions where the patient wears a wristband to monitor physiological signals and learns emotional patterns of the wearer over time. In combination with an app, the user receives a custom action plan, session with a mental health expert and access to a library of educational materials.
Digital phenotyping, which is the analysis of individuals’ digital footprints and their interaction with digital services, provides a digital biomarker to detect signals of mental health or disease. Abilify MYCITE is a digital aripiprazole (anti-psychotic drug) with an ingestible event marker for the treatment of schizophrenic disorders, bipolar disorders and major depression. The ingestible sensor delivers biofeedback to an app in which the patient can further record their mood and wellbeing. The aim is to improve patient compliance and thereby overall improve health outcomes. However, there are some doubts of digital phenotyping and concerns about the intrusive surveillance of individuals and further data is required to prove the effectiveness as outlined in the Human Health Rights journal.
With the broad range of behavioural health software available, certain challenges have been exposed, which the healthcare and technology industry needs to address:
Effectiveness of digital solutions: Scientific evidence is required to evaluate effectiveness and impact of interventions (vs. traditional approaches) and what value they can add to a patient and the wider health economy
Guidelines and regulatory standards: Industry-wide standards need to be developed to guarantee quality and effectiveness. Users will need guidance and indicators that allow them to select the appropriate digital solution for their condition and personal needs
Data privacy: As with any technology which collects personal data, solutions need to ensure safety and privacy especially considering the highly sensitive nature of mental health
Digital access & literacy: Society needs to ensure that those with restricted access to technology or limited digital capability are not left behind to benefit from e-mental health services
The e-mental health landscape is vast and likely to grow further as technology advances. Many of the self-guided digital solutions can be very helpful in offering daily mental support for someone who is (not yet) willing to seek specialist counselling. Apps enable easy access for a large number of people and acts as a vehicle for those suffering to obtain some support. Digital solutions which offer access to professional counsellors or are used alongside wearables can help the patient manage and monitor their wellbeing continuously. The role of e-mental health solutions in opening up access to mental health services and de-stigmatising the topic is also undeniable.
As the opportunity in e-mental health continues to grow for healthcare and technology players alike, we should however keep in mind that these digital tools should be used to complement established in-person therapies and traditional pharmaceutical treatments.