What's Next for Digital Mental Health

Mental health may be the area of healthcare in the greatest need of transformation. Despite progress in science and increased investment by both governments and the private sector, the current system is not working for patients, providers, or payors. The digital mental health revolution was heralded as a potential solution, but nearly ten years into the digital mental health era, that revolution has not lived up to its promise.

Why has innovation failed to improve outcomes? Three issues are paramount.

First, venture-backed telehealth companies generally prioritize access to care and growth more than quality and outcomes. Yes, convenient access has increased the number of people in care. Although only about 40% of behavioral healthcare is virtual, more people are getting more care. Stigma is down; therapy and costs are up. But has more care improved population mental health? The new CDC numbers show suicide mortality in the U.S. at an all-time high. Generally, national statistics for serious mental illness and youth mental health are worse not better over the past decade. Increasing access is not enough.

Second, the lack of regulation of digital mental health has left consumers confused, entrepreneurs unguided, and payors frustrated. Without standards for effectiveness and safety, no one can discern quality or value. While advocates have pushed for parity – ensuring that payors cover mental health the way they cover physical health – there is no focus on accountability – ensuring that providers are delivering care that works. The lack of regulation or accountability would be unthinkable in cardiology or oncology, but mental health has been largely a data-free zone.

Finally, even where high quality services exist, patients and families can’t find them. Google searches steer patients to the companies that spend the most on marketing, not necessarily the companies that have prioritized quality. Some of the best digital mental health companies may be the point solutions, hiring clinicians with deep expertise in eating disorders or OCD or PTSD. These niche companies can’t compete for marketing advantage with the generic online mental health providers. In a world where there seems to be endless demand and limited supply of providers, these companies with outstanding point solutions often have excess capacity because patients can’t find them.

The mental health innovation space requires fundamental change. The way forward is not another killer app or another point solution. We need to fix the ecosystem by incentivizing innovative companies to focus on quality and creating a clear framework for effectiveness and safety. Most of all, we need a mental health ecosystem that serves patients and families.

How do we fix the eco-system of digital mental health? I have been part of one approach called Benchmark Health, a public benefit corporation that is developing a precision mental health platform to maximize the chance of positive clinical outcomes. People looking for mental healthcare receive an Advocate who serves as a trusted navigator, a care coordinator, and an ongoing source of support. The Advocate finds the most appropriate resources – sometimes digital mental health care, sometimes brick and mortar services, sometimes free content and community resources. Some need all of the above.

Beyond navigation, the Advocate follows the member’s journey to maximize engagement and measure outcomes. The outcome data define effectiveness and safety to reveal which resource is best for which problem at what time – that’s the precision mental health platform. Ultimately, the continuous collection of outcomes yields a mental healthcare ecosystem where quality is transparent, and care is accountable. Benchmark Health hopes to create a marketplace where quality is the currency.

Benchmark is one approach. Reliant Health is another. Some digital companies have put a premium on quality. We will need many approaches to shift the digital mental health from a focus on access and scale to a focus on quality and outcomes. The recent Peterson Health Technology Institute report on virtual solutions for depression and anxiety was clear. Digital solutions are effective. They can transform mental health care, democratizing access to evidence-based treatments and highly skilled clinicians. Unlike surgical and medical subspecialties built around office procedures, mental health care can be both virtual and optimal. But this transition requires a focus on quality (with payment for value), a regulatory system that holds providers accountable, and tools to help patients and families find the best care.

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