Panelists Say Innovations in Digital Mental Health Care Increase Access and Deliver Positive Outcomes

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At the American Psychiatric Association 2018 Annual Meeting, held in New York, New York, a panel addressed the role of digital innovation in delivering mental health care.

The Landscape of Digital Mental Health Innovation

Seth Feuerstein, MD, JD, of the Yale School of Medicine’s Center for Digital Health and Innovation, as well as Magellan Healthcare, opened the panel with a discussion of the landscape of digital mental health innovation. Currently, he said, services can be broken down into 3 categories: aggregators, digital therapeutics, and scalers.

Aggregators, said Feuerstein, take different parts of the behavioral health ecosystem—such as screening, care coordination, and disease management—and integrate them. Some accountable care organizations, he said, have begun providing aggregated care portals for patients. Digital therapeutics, by contrast, are intended to treat patients, not only to track symptoms or gather data. Software that treats a patient’s illness could provide a useful option for patients for whom there are no FDA-approved drugs available. Finally, scalers are services that take traditional modalities like cognitive behavioral therapy and offer them to more people through approaches like text-based therapy.

Digital innovations, Feuerstein says, have demonstrated impressive results thus far. He pointed to his study¹ of a computer-based software program, RESTORE, that was tested in patients who had insomnia and comorbid mental illnesses, including schizophrenia and bipolar disorder, who took as many as 10 medications each, and who were poor and primarily in unstable living situations.

The researchers found that participation in the study was associated with significant improvement in insomnia, measured by the Pittsburg Sleep Quality Index score, from week 1 to week 6 (P = .0002). Furthermore, the study had a 6-week completion rate of 90%, which he suggested is far higher than average compliance for pharmacological therapy, especially for this patient population.

“Here’s what’s interesting…subjectively, patients described [the digital program] as by far the most positive experience they have when they go to that center,” said Feuerstein. “Their engagement with it was kind of off the charts.”

The Emergence of Text-Based Therapy

Also presenting was Lynn Hamilton, CPA, MBA, chief commercial officer of Talkspace, a service that allows patients to communicate with a therapist, 5 days per week, via text messaging.

Text is the most commonly used form of communication for American adults under 50, said Hamilton, so texting is a natural approach for patients to connect with care. Text-based therapy also has the positives of addressing challenges of cost, convenience, and stigma.

In pairing patients with the right therapists, says Hamilton, “We’re all about the data.” When a patient signs up for the service, a database query finds the professionals, licensed in the patient’s state, who have the best outcomes for the issue for which the patient is seeking help. As treatment continues, the service also uses assessments to measure the bond between the patient and the therapist.

While some clinicians may worry that text-based therapy can impede the interpersonal connection, said Hamilton, the fact that therapy is not conducted face-to-face allows many patients to feel more comfortable with sharing with their therapist. “The sense of anonymity allows them to open up very quickly.”

Hamilton previewed results from a study, due to be published in the next 1 to 2 months, that found that, among 2869 participants who had used the Talkspace platform for 2 to 3 months, 62.3% said that they were no longer impaired by the issue for which they had sought care, and another 30% said that they had improved.

Hamilton said that text-based therapy won’t replace in-person treatment, but, “For many people, this is an approach that works for them and works for their lifestyle.”

Successes With Digital Mental Healthcare

The final panelist, Kathryn M. Salisbury PhD, executive vice president of the Mental Health Association of New York City (MHA—NYC), discussed the ways in which her organization has implemented digital approaches to mental healthcare.

MHA—NYC administers a variety of programs, including the National Suicide Prevention Lifeline and the NFL Lifeline, which serves “a population for whom stigma is very large.”

The key drivers for MHA—NYC to adopt digital platforms have been the importance of consumer choice in how to receive care; convenience, efficacy, and cost-effectiveness of care; the desire to reach new groups of users who could benefit from the service; fidelity to evidence-based practices; and the need to collect data. In the era of value-based care, she said, “data make the difference.”

With respect to consumer choice, among users of the NYC Well program, which assists patients in crisis, 71.7% choose to use the phone, 23.5% choose chat, 3.3% choose texting, and 1.4% use an online contact option.

When people are given a choice of how to communicate, “They will choose chat or text at least 25% of the time. Some of those people won’t use the telephone if that is the only option,” said Salisbury. It’s not just millennials who prefer to text—a number of older people select the option, she added.

Among the successes of MHA—NYC’s digital platforms is iHELP Sandy, a program that enrolled 4277 individuals affected by superstorm Sandy. The program offered a variety of services to treat depression, anxiety, and other common mental health needs in the wake of the natural disaster.

Through April 2016, said Salisbury, 59% of the individuals engaged in the iHELP Sandy program showed improvement from baseline of at least 24%, and 89% of individuals who had severe impairment had improved by 44%.

Despite such successes, she said of digital mental healthcare offerings, “I think we’re still at the horse and buggy stage…there’s so much more to be done.” The next 3 to 5 years will likely see a great deal more development, and Salisbury encouraged fellow practitioners to be open to technology as a way to expand access to much-needed care.

Reference

1. Feuerstein S, Hodges SE, Kernaghan B, Besserte A, Forselius E, Morgan, PT. Computerized cognitive behavioral therapy for insomnia in a community health setting. J Clin Sleep Med. 2017;13(2):267-274. doi: 10.5664/jcsm.6460.