Digital Health

The digital tools creating scalable access to psychotherapy

Waracle
4th February 2021
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https://waracle.com/blog/digital-health/the-digital-tools-creating-scalable-access-to-psychotherapy/
Digital Health Mobile

Let’s face it. January was a tough month.

Abandoned New Year resolutions fell to the bottom of our list of worries as we navigated continued isolation and heightened anxiety driven by some pretty sombre news cycles. We’ve heard a lot about the social and economic fallout of COVID-19. However, something less well analysed is the psychological impact.

Globally, the pandemic is increasing demand for mental health services, whilst in Scotland, the Scottish Ambulance Service noted that whilst all other 999 calls were down year on year for January, mental health crisis calls were up 9%.

Bereavement, social disconnection, unemployment and fear can all be triggers for new mental health issues…and even worse, it can exacerbate and intensify existing ones.

Samaritans, a mental health charity, fielded 1.7 million emotional support calls during 2020-21 lockdowns and there is also growing concern our health professionals are toiling with mental burnout and fatigue. Dr David Wrigley, the wellbeing lead for the BMA told the Independent, doctors and nurses were being left “physically and mentally scarred” from their work on the pandemic frontlines.

As we prepare for the ‘new normal’, whatever it might look like, concern is growing that the next epidemic may be a mental health one.

The Mental Health Services Bottleneck

This sudden uptick in demand poses a real challenge, as for decades global mental health has faced chronic underfunding and a lack of provisioning. WHO published a report before the pandemic revealing countries typically spend less than 2% of their national health budgets on such services.

In the UK, it’s much higher than that average, at around 11%. However, the general sentiment remains that individuals suffering with their mental health don’t receive the same level or quality of care, as those with other physical conditions.

The King’s Fund found 75% of people with mental health problems in England receive little to no treatment for their condition. This is supported on the supply side with 1 in 10 NHS psychiatrist consultant posts being vacant.

The NHS ‘Five Year Forward View’ set out to tackle this and in their plan, the government concedes they will have to rely on the voluntary and charitable sector to play a significant role in meeting demand shortfalls by the public sector.

Yet, the key issue is the length of time it will take to qualify, train and supervise new staff in what is a highly regulated role while waiting lists continue to grow.

Enter… Digital Mental Health Services

We believe there is a real opportunity for digital therapeutics to deliver a phase shift in choice, access and availability.

Fuelled by the hope that digital solutions could scale up to support a human delivery system that is splitting at the seams, a range of mHealth and eTherapeutic solutions have appeared on the market.

Some of the benefits of e-therapeutic solutions include:

  • Available 24/7 when the need arises
  • Accessed via devices removing initial barriers to care
  • No waiting lists as is often the case with NHS referrals
  • Access in remote geographical locations
  • More cost-effective treatment method at scale

Yet, two key challenges need to be addressed. First, there needs to be a concerted effort to raise the profile of such solutions to generate health consumer awareness and secondly, patients and service users need to learn to be comfortable with a device-first model, rather than in-person first model.

Wellbeing apps, like Headspace (a device-first mindfulness and meditation training app), saw spikes in downloads during lockdown in 2020 with some reports suggesting the wellness category as a whole saw a 200%+ increase year on year in app store downloads.

Ross O’Brien, programme lead for Improving Access to Psychological Therapies (IAPT) suggested this was a direct result of the pandemic and people needing instant therapeutic access. He went on to elaborate that the IAPT sees mHealth’s value in bridging the demand gap for those on public waiting lists, whilst supporting individuals who don’t qualify for referrals if their symptoms are currently less serious.

Many clinical studies show the benefits of early diagnosis. So timely access to care can have life-changing consequences, which mHealth and e-Therapeutics are providing.

These solutions will only get better with time as they mature and evolve to incorporate nascenty technologies. Let’s cover a couple of use cases that we think have star potential across Voice technology.

The Next Generation of Therapeutic Access

Current e-therapeutic design, such as Cognitive Behavioural Therapy systems, are often criticised for being designed too linearly. They lack the fluidity to tackle the evolving and episodic nature of mental health and don’t necessarily think about how to leverage the capabilities of the platform or device to drive engagement.

Digital therapeutics must follow the strict rules-based design whilst balancing the flexibility to meet moment-by-moment needs of the patient, to engage them in a non-obtrusive and simple manner.

One technology gaining ground in this space, which is being actively explored is conversational artificial intelligence (AI). There are two potentials for AI in this space: bilaterally supporting service delivery with clinicians and standalone solutions like chatbots.

AI in Therapeutic Service Delivery

Conversational AI uses a combination of behavioural science, innovative technology like natural language processing (NLP) and advanced engineering to deliver its potential benefits.

In working with human clinicians, AI can be trained to understand context and nuance, gather diagnostic information, facilitate treatment sessions and also review clinician behaviour. Through modelling against star clinicians it can use the intelligence gathered to shape best practices and develop better, unbiased tendencies over time.

AI Voice digital health

However, before NLP is rolled out en masse, researchers need assurances automatic speech recognition systems (ASRs) transcribe sessions to a degree of accuracy they would feel comfortable releasing into the real world.

Some initial sentiment analysis modelling, which assigns more prominence to if conversational AI can understand situation context as opposed to verbatim transcription, have shown it currently performs only slightly worse than human paraphrasing.

Adam Miner, an instructor in psychiatry and behavioural sciences at Stanford School of Medicine, suggests this is very promising. Also adding the technology just needs to be “good” to be of use in it’s initial MVP state.

AI powered Mental Health Chatbots

Chatbots are another application of conversational AI with even more potential to offer scale to therapeutics delivery system.

Woebot, a US startup, is one of the early builds leveraging conversational AI to help people with challenges from depression to pain management. It uses advanced behavioural science, engineering and NLP to send one million messages every week to its users.

It has a daily check-in function which guides the user through varying therapeutic techniques such as Cognitive Behavioral Therapy (CBT), Mindfulness, and Dialectical Behavior Therapy (DBT).

Such approaches are supported by clinical research. For instance, one study from Stanford showed The Woebot led to a 22% reduction in anxiety and depression for people aged 18-28.

Scaling up, these already promising advancements in therapy delivery and chatbot technology could offer a solution to the impending jump in demand for mental health services globally.

Digital technologies are paving the way to a land of new opportunities and potential for global mental health provisioning. Backed up by hard data, conversational AI and mHealth applications to drive real, timely results for a society slowly coming to terms with it being OK not to be OK.

Waracle has extensive experience in the Digital Health sector. If you have plans to bring a solution to market and need a software development agency to collaborate with, you should look no further, get in touch with our team today!