Mental health is an often-overlooked component of patient care. According to the World Health Organization, good mental health allows individuals to realize their own abilities, cope with normal stresses of life, work productively and fruitfully, and make contributions to their communities.
Mental health is influenced by life experiences and a variety of biological and psychological factors, and it should be considered an equal contributor to a person's health status as his or her physical and social well-being. Those with mental health problems are also susceptible to behavioral health disorders, which can lead to higher rates of chronic illness and reduced life expectancy.
See the findings: How to evaluate mobile health apps for high-risk patients
Mental illness is also widespread. According to surveys by the Substance Abuse and Mental Health Services Administration (SAMHSA):
Unfortunately, the US health care system has historically separated the diagnosis and treatment of mental and physical illness, negatively impacting care coordination, the cost of care, and insurance coverage. The mental and behavioral health field also faces a shortage of specialists, and a lack of inpatient psychiatric beds (see figure below). Spending on mental health services is projected to reach roughly $239B by 2020, which would account for 5.5% of total health spend by that year.
Primary care providers can perform basic mental health screenings (e.g., depression, substance abuse), prescribe medication, and make referrals to specialists, but psychologists, psychiatrists, and other related roles operate largely on their own.
From an IT perspective, this division has kept many mental health providers out of the loop in health information exchange networks and EHR data sharing.
Mental health is receiving renewed focus amid the opioid crisis, school shootings, and rising suicide rates. In its 2018 Midyear Funding Review, Rock Health notes that behavioral health startups received more investment in H1 2018 than in any prior six-month period, with 15 companies receiving a cumulative $273M in funding.
Many technologies can help capture patient mental health data in near real time, and on a daily basis. Wearables, telehealth, social media, virtual reality, mobile apps, and the internet of things offer ways to identify physical, social, and behavioral factors related to mental health. Technology can also help to engage patients in their own care, monitor response to treatment, and predict future illness.
Here are just a few ways health systems and companies are looking to address mental health:
Mobile apps are of particular interest to health providers and researchers as a means to evaluate mental health. According to IQVIA, there are thousands of mental health apps available today, and these apps make up the largest proportion of total health apps that provide disease-specific support and management, focusing on conditions such as autism, depression, anxiety, and attention deficit hyperactivity disorder (ADHD).
Mental health apps fall into a number of categories, including self-help (e.g., medication reminders, tracking stress patterns), assessments (e.g., improving memory), and illness management (e.g., provider-directed therapy, social support networks).
However, while mental health apps can act as a supplement to traditional in-person therapy—and also provide greater access, convenience, scale, lower cost, and the possibility for anonymity—there are a number of challenges to address. With little industry regulation and peer-reviewed research, it is difficult to assess which apps are validated, effective, and secure.
The idea of digital therapeutics, or "digiceuticals," is that verified apps can deliver behavioral and mental health treatments for patients in place of traditional (and costly) therapy. These digital health apps must go through rigorous clinical testing to prove their efficacy, and they may seek regulatory approval by agencies such as the FDA before being prescribed by a doctor.
Of particular interest is whether digiceuticals could eventually act as a standalone treatment to reduce a patient's reliance on drugs—although in some cases, such apps would merely complement a medication regimen. Some companies operating in this space include Pear Therapeutics and Akili Interactive, which are testing apps to treat depression, ADHD, schizophrenia, substance abuse, and other conditions.
As with other emerging fields, the digital therapeutics market is experiencing a flurry of startups looking to fill demand. A report by Frost & Sullivan estimates there are already roughly 100 companies attempting to introduce digital therapeutics services.
Given the crucial connection between mental and physical health, hospitals and health systems need to treat patients holistically—especially as more providers shift to accountable care organizations and other risk-based contracts that tie payments to outcomes.
Here are some additional considerations for organizations wishing to use IT to identify, assess, and treat mental disorders:
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