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.

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Mental illness is also widespread. According to surveys by the Substance Abuse and Mental Health Services Administration (SAMHSA):

• Nearly one in five US adults lives with a mental illness (i.e., a mental, behavioral, or emotional disorder), with fewer than 50% receiving any treatment; and
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• Between 4 to 5% of US adults suffer from a serious mental illness (i.e., a serious functional impairment that interferes with one or more major life activities).

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.

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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.

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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:

1. Intermountain Healthcare recently launched Alluceo, an independent company that integrates mental and behavioral health care into primary care using a digital communication platform and a team-based care model;
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3. Atrium Health established a centralized tele-mental services unit that virtually links its primary care offices and emergency rooms with behavioral health experts. A pre/post-intervention analysis showed primary care patients experienced a 45% relative decrease in depression and anxiety symptoms and a 27% decrease in avoidable hospitalizations, saving the system $78,000;
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5. The University of Southern California Institute for Creative Technologies created a VR-based exposure therapy tool called Bravemind, which allows clinicians to control, document, and measure patient responses in immersive environments. Bravemind has been used to assess and treat post-traumatic stress disorder for military veterans;
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7. myStrength uses a mobile and web-based self-care platform to provide education and coping skill development tools for self-motivated patients with behavioral health needs (such as depression, anxiety, and substance use). Machine learning algorithms individualize the patient experience, with the platform highlighting therapeutic resources consistent with user preferences;
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9. Quartet Health, Lyra Health, and Ginger.io are other companies that have created technology platforms to connect mental health and primary care providers, patients, and employers for more collaborative care. These companies use machine learning algorithms to match patients with mental health providers, and they can facilitate both virtual and in-person therapy sessions. Digital coaching and self-guided therapy through mobile apps are another component to these platforms; and
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11. Otsuka Pharmaceutical and Proteus Digital Health last November received marketing approval from the FDA for Abilify MyCite, a sensor-equipped pill that allows clinicians to remotely monitor medication adherence. Abilify MyCite is an antipsychotic used to treat schizophrenia, bipolar disorder, and depression.

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What's on the horizon: 'Digiceuticals'

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.

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Additional considerations for providers

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:

• Technology still needs time to prove itself. Technology won't replace mental health clinicians anytime soon, but smartphones, virtual assistants, and other digital tools can certainly complement traditional therapy and help close some gaps in care. Such tools will be particularly effective if they can help patients self-manage their symptoms and reinforce therapeutic lessons in their daily lives;
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• Patient engagement is critical to success. Although apps and other IT platforms hold promise for mental health, they are not a quick fix for patients with complex clinical and social needs, and won't make a significant impact unless patients are truly engaged in their care. Make sure to invest in the basics of chronic disease management (e.g., self-management education, psychosocial support) before incorporating new technologies in patient care; and
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• Whether building or buying mental health IT tools, implement strict quality controls. Tools such as mobile apps should employ validated evidence-based cognitive techniques, offer intuitive design, include elements of gamification to sustain user engagement, offer customization where possible, and ensure data privacy and security. Ideally this data would also integrate with EHRs without disrupting clinician workflow. Creating an app development checklist can help to evaluate product features. The majority of mental health apps haven't been properly vetted, and while many developers may enter the mental health space with good intentions, that doesn't mean they understand the needs of clinicians or patients. When using a third-party solution, evaluate whether:

1. The product has been tested for its intended audience and in real health care settings, including any evidence from randomized controlled trials; and
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3. Behavioral and mental health professionals (e.g., psychologists, therapists, social workers) work for the company or contributed to the development process.