Over the last decade, our individual awareness and understanding of mental health has risen to unprecedented levels. Despite its pitfalls, social media has been pivotal in exposing the harmful stigma around mental health, as well as providing a platform for sharing resources. Now, two years since the outbreak of COVID-19, the conversation around mental health is more important than ever before; approximately one in five adults in Great Britain experienced some form of depression in the first three months of 2021 – over double the figure before the emergence of COVID-19 in the UK in March 2020. The numerous lockdowns and periods of social isolation have exacerbated an issue that has long been underdiagnosed and widespread.
Like all other fields of healthcare, the pandemic accelerated digital innovation because everything went virtual overnight. It worsened social inequalities, and the digital divide became evermore prominent. However, this period also led to the proliferation of mobile apps, as healthcare was forced to become mainly remote. Mental wellness apps boomed, as people found themselves grappling with the many demands and stresses of lockdown life. A 2020 report from App Annie found that downloads of mindfulness apps hit 750,000 during the week of March 2020, up by 25% from the weekly average in January and February that year.2 Calm, a popular wellbeing app, was particularly successful, and saw 3.9 million downloads in April 2020.
By bringing about the digitalisation of healthcare, the pandemic inadvertently accelerated healthcare’s push towards greater innovation to support patients worldwide.
As applications and virtual healthcare appointments become the norm, there are now more avenues than ever to help us manage our mental health. The Global Mental Health Apps market size is forecasted to reach $10.2 billion by 2027, mainly owing to the rising awareness of mental health.3 Smartphone apps have created ease of accessibility in this field, in areas such as diagnosis, symptom tracking, and self-management. The latter in particular has allowed patients to access support regularly and at their fingertips. For many, a lack of financial stability has led to inconsistent and/or inadequate treatment for conditions such as depression and anxiety. People also may be prevented from disclosing their mental illness to friends, family, and work colleagues alike, due to the fear of being treated or perceived negatively.
Self-management apps therefore offer a safe and private method for people to practice self-care in their own time. A study from 2017, conducted by the Department of Health Science, Brigham Young University, found that 90% of people who tried a mental health app reported improvements in motivation, confidence, and attitudes about their mental and emotional health.
Mobile apps play a vital role, particularly for those who are ashamed to seek professional help due to the associated stigma. They offer a safe, private solution that is often more affordable than healthcare, particularly in countries with high medical bills, such as the US. They can be used in conjunction with medications and face-to-face therapy, to help transform treatments and open a new door for the self-management realm. These tools, whilst not intended to be a substitute for one-to-one care, can be instrumental in helping patients form new and healthier habits. Now, how can GPs/HCPs use these apps to their advantage to improve outcomes and the quality of life for patients?
Let’s get digital
Social media has both helped and hindered mental health throughout the pandemic. Whilst it undeniably comes with a lot of risk, including heightened insecurity and fear of missing out (FOMO), social media has been a catalyst for greater discussion on mental health, through raising awareness of apps that people can download for ease-of-access to care. In 2020, a Reddit user built a free mental health app after being stuck in their small studio at the height of the pandemic. The final result, a platform offering self-management exercises such as breathing techniques and a secure private journal, aims to compartmentalise tasks to make them more digestible, and less overwhelming. After sharing Happy on the Reddit forum r/mentalhealth, the user received 406 upvotes, and other users shared their experiences in the comments section. One such user shared, “Having some of the worst times of my life right now. I’ll give it a try. Thanks for using your time to help broken people like me.” Another praised, “I love the simplicity of it, it’s so useful.”
However, not all people are comfortable with the idea of therapy apps – one user on Reddit shared they are weary of them, “especially since there are no laws about confidentiality protecting your privacy the way there are with therapy. App companies can still collect all of that sensitive data about your personality and habits and sell them.”
For many, taking therapy sessions through an app also does not replicate the connection that is fostered in person between their therapist and their client. When attending in person, patients know that they are coming to a familiar, safe, and dependable address; some may see this as their only safe place. When it comes to online therapy, however, some may find it difficult to feel connected to their therapist. As phrased in a 2020 article on welldoing.org, titled The Differences Between Face-to-Face Therapy and Online Therapy: “Online psychotherapy requires a different kind of listening and a different kind of intensity. The senses are reduced to one or two: to sound, and to sight.”
Virtual therapy platforms such as Sensa are heavily based on cognitive behavioural therapy, and are developed with assistance from experts. Prior to signing up, Sensa offers the user 27 questions, centred on their goals for therapy and what they hope to learn from it. Prospective users are also asked to answer questions on both physical and mental symptoms they may have experienced, of conditions such as depression, anxiety, and insomnia to help customise their experience. The platform then uses these data to tailor the user experience.
Sensa offers users self-management options, such as self-paced lessons on mental health, mood journaling, and habit-building tips and strategies. With access to services such as these, people can unlock a new door to self-awareness at their fingertips.
Pharmafocus spoke to Dr Andy Blackwell, Chief Scientific and Strategy Officer regarding the role that digital innovation is playing in mental health systems globally. ieso is a data-driven AI healthcare company, currently working to make its digital therapy service available to more than 20 million people in the UK via existing partnerships, including with the NHS. Dr Blackwell told us: “Digital innovation in mental health is currently transforming access to mental healthcare. However, access is not enough – there must also be a focus on quality and outcomes. “We believe digital innovations, that engage patients and show real-world evidence of efficacy, will ultimately be industry leaders in the future of mental health care. Further, the insights from a data-rich sector like digital therapeutics can generate will help clinicians to make more accurate diagnoses, to optimise and personalise treatment decisions and to eliminate unnecessary or ineffective practices.”
Prescribe a platform
There are numerous apps that are recommended on the NHS for mental health care, such as Calm Harm, designed to help people resist or manage the urge to self-harm. The app provides immediate activities and techniques to help break the cycle of self-harm behaviour. It is private, anonymous, and safe, helping the user to be as comfortable as possible. Platforms for symptom tracking, such as My Possible Self, are also NHS approved. This offers simple learning modules to manage fear, anxiety, stress, and tackle unhelpful thinking.
Zuellig Pharma has also licenced Ensemble, Happify Health’s transdiagnostic prescription digital therapeutic for people with major depressive disorder (MDD), generalised anxiety disorder (GAD), or both. The platform requires a prescription, and teaches people new skills and habits to take control of their symptoms. Murray Zucker, MD and CMO at Happify Health, stated at its launch in Summer 2021: “The connection between mental and physical health is clear, which reinforces the need for early diagnosis, treatment and ongoing care and support that can only be delivered at scale using digital therapies.”
Viva la Virtual
Virtual therapy is a new option accelerated by COVID-19’s introduction, where users can have online consultations with a licensed counsellor. Log on, find a licenced counsellor, and have the consultation in the comfort of your home. A 2020 article from Tata Consulting Services (TCS), entitled The Future of Therapy: Building Empathetic Technology, states, “Providing a smartphone-based app to patients to access therapy and track their own progress is a great way of promoting self-care. That’s because tracking the patient’s lifestyle and behaviour in a non-intrusive manner is as important as medication in many health conditions. Take for instance the case of substance abuse, where prescription digital therapeutics for mental health, as adjuncts to clinical consultation, are already showing encouraging results for substance dependent patients.”
The article also stresses the need for a more human approach to improving people’s mental wellbeing, and how the element of empathy is crucial to the development of new smartphone apps: “While technology offers many tools and models to foster physical and mental wellbeing, the future of therapy will depend on identifying the right combination of technology coupled with empathy through human support. It is the only way to scale therapy and offer personalised support for those with mental illnesses. New therapeutic interventions are emerging… clearly, blending technology with empathy is a novel way forward towards managing and initiating treatment in the area of mental health.”
Whilst virtual therapy may not be for some, the effectiveness of these apps for the majority cannot be understated. In 2017, Carlbring et al reviewed 20 studies which compared the efficacy of CBT delivered online with face-to-face interventions. They found that online interventions produced an equivalent overall effect when compared to face-to-face therapy.5 Evidently, while virtual therapy may require a slight adjustment on the individual’s part, they are accessible and inclusive in bringing the therapy to the individual.
Technically speaking
Like in any other field, digital innovation in mental health comes with its own unique set of challenges. It is important to acknowledge that these are not substitutes for treatment, and rather are forms of self-management that can be add-ons to professional help. As we have explored, empathy is instrumental in making a therapy app effective for the user, to replicate the connection that occurs in person between a therapist and their client as best as possible. As the potential of digital therapeutics becomes increasingly recognised in the pharma industry, it is clear that they show promise in continuing to shape the landscape of mental healthcare. The future is certainly looking bright.
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