Are we there yet? – Digital disruption in mental health



October 4, 2017 6:53 am

Are we there yet? – Digital disruption in mental health
Jono Nicholas, CEO of ReachOut

I went to see my GP recently. My seat in the waiting room was uncomfortable and covered in a salmon coloured, plastic coated, fabric. I reached over to read a magazine from 2015 and settled in to wait for the doctor who was running late.  Twenty minutes later he ushered me into a consultation room where I sought a referral to a specialist. The appointment lasted less than three minutes but wasted more than an hour of my time.

In a world where almost every industry has been disrupted by technology, how has healthcare remained strangely immune? If Google, Apple or Amazon ran our healthcare system how would it fundamentally change? And would those changes be for the better or worse?

Almost twenty years ago, the first digital mental health service, ReachOut was launched. Since that time technology has had a significant but far from transformative effect on the mental health system. Even now, digital services are seen by policy makers as interesting but relatively marginal to the mental health system. They are poorly integrated with the rest of the system and receive little public or private investment. This is despite strong evidence as to their effectiveness and potential to meet the significant unmet demand in the system.

Despite its resistance, there are some signs that healthcare is ripe for quick and transformative change. As outlined below, mental health is facing a perfect storm of conditions that make it the most likely part of healthcare to be disrupted including:.

  • Large potential market – At any given time, 25% of people will experience a mental health difficulty. As awareness of mental health rises and stigma reduced, the population that is interested in investing in their mental wellbeing will increase significantly.
  • High community dissatisfaction – I have not met one person who thinks their country has a world class mental health system. This dissatisfaction creates a strong desire for change.
  • Highly regulated – In many countries governments either directly deliver or control through funding, the mental health system. As a consequence, substantive change will have to come through disruption rather than incremental change.
  • Provider controlled – There has been a strong move in recent years towards consumer participation in mental health. The fact this is called out is the strongest evidence that “consumers are not in control” and their satisfaction with the services rendered very rarely taken into consideration. Thus they have little loyalty to existing services and could shift quickly when the opportunity arises.
  • Digital bias – A large number of mental health interventions can be delivered safely and effectively via digital means. As a result the opportunities to disrupt mental health may be superior to any other part of healthcare.     

If the above are accepted as preconditions for disruption, then the question is when will it happen? This is a difficult to answer precisely but a number of events have occurred recently that suggest transformative change may be close, or even under way. These include:

The circling of the digital giants –  For their own reasons Alphabet and Facebook have become engaged in mental health. For example, Google recently launched a depression screening questionnaire directly into its search results. In 2015, Alphabet poached the Director of the NIMH, Tom Insel to oversee the creation of its mental health program within their life-sciences division. They have the capability and the capital to quickly become the biggest player in mental health.

The formation of well capitalised startups – Tom Insel recently left Google to start a new venture, Mindstrong that will try to infer a person’s mental health status by analysing how they use their smartphones. The meditation company Headspace has raised $73m in venture capital with a market valuation above $250 Million. Crisis Textline also raised $24 Million to scale its operations. This indicates that mental health may be about to attract the capital needed for transformative change.

Each of these are indicators that the economic environment around mental health is changing. As a consequence, any organisation in mental health should be making active preparations to understand, adapt and thrive in the new environment.