Mental healthcare is about helping patients manage their illnesses in the ways that work best for them. When governments across the country temporarily expanded access to digital health services in response to the COVID-19 pandemic, millions of Americans found a transformative answer to their long unmet needs. During Mental Health Awareness Month 2023, and as those emergency policies expire and barriers to access return, philanthropy finds itself suddenly and uniquely positioned to contribute to mental health all along this digital frontier.
A visible crisis
Mental illness in America has been called an “invisible crisis” for so long that it’s no longer true. The evidence is everywhere. More than 57 million adults and 7 million children suffer symptoms every year. The 40% increase in “feelings of persistent sadness and hopelessness” among U.S. youth between 2010 and 2019 — and a 31% increase in teen mental-health-related ER visits during the pandemic — forewarn a rising tide of emotional scarring for decades to come.
Making matters worse, one of the leading contributors to the mental health epidemic is a lack of access to care. Most Americans with mental illness go untreated altogether, and members of racial minorities get help in even fewer numbers. A 2022 survey found that 42% of Americans with behavioral health issues did not seek out care because of barriers like costs and limited insurance coverage. That’s why the significant increase in patients seeking help for mental illness since 2020 has been such welcome news. Digital mental health technology has played a central role. As soon as lawmakers, payers and providers embraced digital mental health technology during the pandemic, millions of Americans who had never sought counseling before did.
And it worked.
The future was then
One study found that “digital mental health services including telecoaching and teletherapy were effective in improving subjective wellbeing and clinical improvement in depressive symptoms.” Another found that telepsychotherapy was as effective as in-person therapy for veterans with post-traumatic stress and seniors suffering depression. More than 95% of clinical psychologists now offer at least some services remotely. And 60% to 80% of Americans support digital mental health services and are open to using them.
During pandemic social distancing, Americans embraced telehealth across all medical specialties. It is not surprising that mental healthcare, which consists primarily of talking and listening, saw a major boost during those stressful months.
With COVID-19 increasingly in the rearview, the rules governing digital mental healthcare are among the myriad things “going back to normal.” But for digital mental health, that old “normal” means reinstating access restrictions. The mental health provider shortage did not disappear over the last three years. A majority of U.S. counties still lack a psychiatrist and 70% lack a child psychiatrist. And demand for care continues to rise faster than policymakers can possibly update all the relevant statutory, regulatory and budgetary issues involved.
All this is to say, we know digital tools can help America meet our growing mental health crisis. With more than 85% Americans owning smart phones, the potential for digital care is almost limitless. Private investors certainly think so, having poured more than $8 billion into mental health enterprises in the last two years alone. But we also know that digital mental health is still young — a dynamic, fluid field operating on the frontiers of technology, medicine and public policy. What’s needed now is bold leadership that can harness all three sectors to create a new vision for digital mental healthcare that offers patients the best and most equitable care that private, public and scientific partnerships can deliver.
If digital mental healthcare is a frontier industry, then part of the work ahead of us is bringing some order to it. Enter philanthropy.
Philanthropy’s opportunity
Philanthropic institutions are perfectly situated to innovate in the space between policy, business and healthcare.
One high-value project would be vetting all the software and devices flooding the digital mental health market. Different apps have different strengths and weaknesses in terms of their diagnostic features, cultural relevance, user-friendliness, etc. But to date, no one has comprehensively reviewed their various qualities.
Nor has anyone solved the problem of connecting minority communities with mental health professionals who share their cultural background — yet another care and equity hurdle that digital apps could help patients clear.
Apps also need to be as safe and private as a visit to the doctor’s office. Companies and government health programs are more likely to use and cover apps that have met standards of safety and privacy, as well as additional criteria of clinical effectiveness. The U.K., the Netherlands and Australia all currently fully reimburse for digital mental healthcare, showing what’s possible. And the sheer magnitude of technology’s scaling effect could also create opportunities outside traditional third-party reimbursement.
The U.S. Agency of Health Research and Quality recently proposed a framework for evaluating apps based on efficacy, privacy and clinical relevance. The Society for Digital Health is currently convening experts, practitioners and policymakers to refine this work with an eye toward establishing standards and a pathway to reimbursement.
Artificial intelligence could play a role, too — helping patients, providers and payers crunch the massive compilations of data about different mobile apps. Standardized analysis like this is a crucial step toward expanding access as quickly as possible, while also enabling real-time course corrections based on real-world evidence.
Eventually, the “killer app” for digital mental health may expand what it offers beyond evaluation into recommendation. One can envision a digital formulary modeled on the drug and medical device formularies that insurers and pharmacies use to make coverage determinations, or even a tool that predicts more than dollars. Philanthropists could build an evaluation tool to catalog apps that specialize in specific treatment modalities or serve specific at-risk populations with culturally competent providers — forecasting the social as well as the financial value of each app.
Like Amazon, which functions as much as a platform for merchants and distributors as for consumers, philanthropy could spur the growth of digital mental healthcare on the demand and supply side.
Successful digital solutions usually have embedded rating systems. They help new apps — think Uber or Travelocity — leapfrog legacy systems and bring consumers and innovators into direct, value-adding contact. An independent, impartial rating system developed by philanthropy could do the same in the digital mental health space.
Doing so would help address challenges private capital won’t touch because they’re too complex or serve a market too small. On the other hand, it would help the public sector reboot its strategy, which today too often relies on the police to answer most mental health emergencies — the opposite of the kind of inclusive, preventative, positive care most mental illness needs. Rather than duplicating the work of private enterprise or public policy, philanthropy can also take on app development, tackling social needs that are now being left behind. Venture philanthropists like Hope Labs, HeadstreamInnovation and Stand Together Ventures are already starting to invest in apps that serve these needs.
The gap between America’s mental health needs and mental healthcare can be closed. Everything we saw during the pandemic, and everything we know about personalized technology in other sectors, tells us so.
Digital apps can bridge the gap between the fractured, unsustainable status quo and an inclusive, equitable, healthier future. By focusing on social returns while the market focuses on financial returns, philanthropy can catalyze these transformative innovations, reaching millions of patients now needlessly suffering without treatment, and shaping the future of both technology and mental health.
Anna Bobb, MPH is founder and managing partner of Vredeveld Strategies, a philanthropy advisory firm based in Washington, D.C.
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