If technology is the problem, can it also be the solution?
The must-see Netflix documentary, “The Social Dilemma,” released early this year, draws attention to the link between heavy smartphone use and mental health disorders like anxiety and depression. But there’s a paradox brewing, because the latest solutions for mental health ask people to spend more time on their phones.
Digital mental health is trending. Think texting your therapist via Talkspace or meditating with Calm. Five of the top 10 venture capital-backed mental health startups are smartphone apps. The top 20 mental wellness apps were seeing 3 million new downloads per month before Covid-19 began striking hard in March, which grew to 4 million in April.
While the expanded access to mental health resources is remarkable, these products face two contradictory goals. Technology is built to engage, to keep us logged in for as long as possible. But if excessive screen time is worsening mental health issues, good mental health care should probably help us disengage from our phones.
Is it possible to have both a successful tech product and an effective form of mental health care? We think the answer is yes — as long as digital mental health companies adopt three best practices.
Mental health well-being first, venture capital metrics second
When pitching investors, digital startup founders tend to emphasize app downloads, active users, and customer lifetime value. These metrics inform revenue and growth potential. But they indicate the business’ health, not the user’s. It is essential that digital mental health startups understand the difference, even while chasing both.
To assess quality of care, it’s important to look at patient-reported outcomes. How has the user’s quality of life changed during the course of treatment? How is their mood, sleep, and productivity? Like traditional therapists, providers on the other side of the app should use evidence-based scales to diagnose patients and monitor their improvement, such as the PHQ-9 for depression or GAD7 for anxiety.
The challenge with an engagement metric like time in app is that it says nothing about quality of care and, if anything, might be harmful to the user who, thanks to the app, may have become more glued to their phone. Paying providers based on patients’ time using the app, or even their own time in the app, is antithetical to effective mental health care. Provider compensation should be tied to quality of care, not quantity of care.
One path forward for digital mental health startups is to focus on payer partnerships. Companies that prioritize the right metrics and show improved patient outcomes are more likely to get commercial health insurers and employers to pay for their mental health solutions.
There is still a place for classic venture capital metrics like customer lifetime value, but rather than keeping individuals hooked (which is poor medical practice), value comes from serving new patients every year through partner health plans.
Replicate the boundaries of traditional therapy in a digital world
In adapting therapy for mobile, developers have added new features. A popular one is 24/7 access to a therapist via text, which certainly drives engagement. Digital tools are fundamentally changing what mental health care looks like. While innovation is important, it is essential not to forget that the methods of traditional therapy have been tried and tested, and that there is science behind them.
Meeting with a therapist at a regular time and place creates a frame, a distinct environment in which to work on mental health so that issues interfere less with daily life. In the traditional setup, patients have ways to contact their therapists in case of emergency, but are encouraged to internalize coping strategies so they become more instinctual and less dependent on external reinforcement. Patients practice and learn between appointments how to quell their anxiety independently, or how to let it subside on its own. That incentive disappears with 24/7 texting and with any app that prioritizes user engagement over patient progress.