The Mental Health Crisis
Accessibility and personalization are key ways that technology can help solve it
Welcome to issue #17 of next big thing.
A couple of weeks ago, I went on The Full Ratchet podcast with Nick Moran to discuss my series of essays from July about the venture capital industry. Check it out here.
It’s been three weeks since my last post, which was about the climate crisis. I took a week off and spent a few days off-the-grid in nature. But the past few weeks since returning to San Francisco have been challenging. Smoke from wildfires across the west coast of the U.S. have made the air quality very poor, and I’ve barely stepped outside my home during this time. I’ve also found it difficult to write.
The time indoors and the combination of crises we are currently facing made me reflect on my frame of mind, and that of others, given what we are all going through. I tweeted the following on Friday as a summary of where I think we are:
Today’s essay explores that fifth crisis: mental health.
While the pandemic has disrupted life for many, it is increasingly clear that it has accelerated trends that were already underway.
One of those is a mental health crisis that is becoming increasingly dire in the U.S., both in terms of the number of people it affects, and the pressures it exerts on the healthcare system.
A study published in 2016 in Health Affairs found that mental disorders topped the list of the most costly medical conditions in America, at over $200 billion in annual spend.
A study published last month by the Centers for Disease Control and Prevention (CDC) in the U.S. found that symptoms of anxiety disorder has increased 3X in the past year, and depressive disorder 4X. Several populations, such as Blacks and Hispanics, essential workers, unpaid caregivers, and young adults, are having disproportionately worse mental health symptoms. Much of this can be directly linked to covid-19.
In the CDC survey of over 5,000 Americans, over 40% of all respondents reported an adverse mental or behavioral health condition. Because of the stigma associated with disclosing mental health conditions, and because of the combination of crises we are currently facing (including the climate crisis as exemplified by wildfires over the past few weeks), I wouldn’t be surprised if the actual percentage is higher. It’s plausible that over half the population right now has symptoms associated with mental health conditions. Even before the pandemic, more than 60% of Americans reported feeling lonely, for example.
It is terrifying to consider what the downstream and ripple effects of this could be. Mental health feels like a more important problem to work on than ever before.
While technology can and should be a big part of the solution, it’s important to acknowledge that it’s also played a role in causing this crisis.
A conversation between scientists in Nature offers a good primer on the positive and negative effects of digital technology on mental health. There is increasing evidence that social media, in particular, has a detrimental effect on the mental health of teenagers. There’s also research that shows that anxiety and depression can “spread” within social networks. And younger, already at-risk, adults are particularly prone to mental health issues through the use of technology, as this Duke University study finds. If you think about your own relationship with technology, particularly over the past six months, I’m sure you’ll find instances where screen time or content online have made you feel worse, perhaps even on a recurring basis.
But, as the Nature piece points out, technology can help improve mental health too. Analyzing user data can help detect signs of suicidal actions and enable interventions. It can also help diagnose and treat eating disorders or substance abuse. If we develop the right technology products, more people can get help as they deal with symptoms of mental illness than ever before.
I’m an optimist. I’ve bet my career as a venture investor on technology being a force for good, and on entrepreneurship as a way to solve many of the world’s challenges. And so it goes with mental health.
If I could summarize the low-hanging-fruit opportunity in mental healthcare in one word it would be accessibility.
The internet and smartphones can enable more people to get access to mental healthcare, and there are many companies working on this.
Sarah Du published a great post last month mapping out over 70 companies in mental health technology. Across the six categories Sarah identified — self-care, chatbots, peer-to-peer, telehealth, digital therapeutics and hardware — there are many companies working to increase access to care.
The cost of mental healthcare is far too high for most people today, and that is partially a result of a shortage in psychiatrists, therapists, and other mental health professionals. Demand for care outstrips supply, and many patients also end up paying out-of-pocket for mental healthcare. Far too few treatments are covered by insurance today, and that must change if we are to address this crisis. Regulation and policy can also help expand access, such as recent changes to telemedicine laws.
Technology can enable clinicians to see more patients, more clinicians to get in-network with more insurance plans, for care to be delivered synchronously and asynchronously through video, audio, and text, and for the cost to be driven down to patients as a result.
Hanel Baveja at USV has a nuanced take on where the mental healthcare market is going in her recently published Mental Healthcare 3.0 two-part series. While 2.0 companies such as Calm and Talkspace enabled human care to be delivered digitally, and enabled more access through on demand care, 3.0 companies will offer fully-digital or hybrid human-digital care and enable more people to get access to affordable mental healthcare at anytime.
Hanel Baveja of USV’s thesis on Mental Healthcare 1.0, 2.0, and 3.0
Hanel also posits that narrow market wedges, such as care focused on a particular community like the LGTBQ community, or illness such as eating disorders, can improve access, and that non-video products can further de-stigmatize care and lead to more people getting help.
A founder I chatted with this week, Cole Egger of Listeners on Call, stated that there are four points of friction to delivering great care to mental health patients in today’s system: Cost, Convenience, Stigma, and Compatibility. The first three can be solved through technology that we already have, and all three fall under the umbrella of accessibility. But the fourth, compatibility, touches on the promise of technology in the future to revolutionize mental healthcare.
The real opportunity in mental healthcare, beyond accessibility, is in personalization. Getting the right type of treatment, as well as preventative care, to an individual based on lifestyle, personality, and symptoms should one day be possible.
How could a company get there?
First, gathering and analyzing data from patients and therapists will be critical to building a personalized solution. The good news is that smartphone data, sensor data from products such as Apple Watch and fitness devices, and user-reported data, is all available and more analyzable than ever before.
Second, understanding both qualitative and quantitative measures of treatment outcomes will be necessary to improve care. Figuring out what “successful” care looks like in the context of mental health is a hard problem to solve, but “closing the loop” with outcome data, as my friend Andrew Barr describes, will be key to figuring out how to match the right type of care to the right person.
Third, we throw around buzzphrases like artificial intelligence and machine learning often in our industry, but they do hold the promise of automating aspects of care, and of making critical interventions to treat mental health issues that would be tough for human clinicians alone to perform.
A company from a very different industry may help illuminate a path to a personalized solution to mental healthcare. Stitch Fix has built a personalized styling service accessible to anybody through an eCommerce experience. As founder and CEO Katrina Lake describes in this HBR piece, it’s taken the work of dozens of data scientists, and a combination of algorithms and human curation, to develop a great consumer experience. The Stitch Fix experience gets better over time from more data inputs and outputs.
A chart from Stitch Fix’s 2017 S-1 Filing showing how the service integrates data science and human judgment.
I think a similar formula can lead to a much better mental healthcare experience than today’s status quo. The human touch of psychiatrists and other clinicians is very important to deliver a great solution for many patients, but it can be augmented by algorithms, data, and technology to make offline and online care as tailored as possible. There are already healthcare technology companies like Livongo, recently acquired by Teladoc for $18.5 billion, that are leveraging data to provide personalized care, showing how big the opportunity can be for companies that crack this code.
I can’t wait for the next big thing to get built in mental healthcare, helping the millions of people suffering from conditions right now, and in the years to come. It will increase access to care, and one day it may also enable the right care to reach the people who need it.
Thank you to Andrew Barr, Hanel Baveja, and Sarah Du for your feedback on the draft.
one of my worries about mental health startups and venture is that this type of capital implicitly and explicitly pushes for large scale, binary outcomes. How does the needs of the investor match careful, high quality growth for companies in this important area. Does it strand companies that could have been profitable, if smaller businesses, in the Series A-C gap of 'not growing fast enough but struggling to get off the venture curve' - what happens to those company's customers? It's a PITA when your expense software company goes under. It's worse when you've lost access to your real/virtual therapist/support group.
Excellent article. Mental health is not discussed enough as being one of the major negative effects of the pandemic lockdown. Without increased social acceptance of mental health as an issue AND accessibility to in-person and/or digital healthcare options, things could worsen. I certainly don't want that, but the growth in mental health problems continues to be a major problem.