Covid-19 has brought to the fore the looming mental health crisis; even before the pandemic, the mental health state of the world was not exactly rosy with one out of 4 adults suffering from lifetime incidence of mental illness and during emergencies the prevalence is more like 1 in 5 people. During Covid, due to additional stressors such as: fear about catching the illness by self and dear ones; loneliness due to social distancing; aggravation of domestic abuse; and stress due to actual / perceived fear of loss of employment, things have gone south.
As per a recent APA poll, more than a third of Americans are feeling that the Covid-19 has seriously undermined their mental health, however not all is lost and there is a silver lining. Despite sky high anxiety, behavioral impacts have still to be seen and that provides a valuable window for intervention.
According to a WHO-led study into depression and anxiety, interventions can really help and treatments can lead to four fold returns. At the significant cost of $1 trillion there is economic logic in investing in mental health and more importantly, moral logic in alleviating suffering and preventing loss of life (due to suicide) and reducing DALYs.
More and more interventions are moving online and delivered using the latest technology; be it the recent emphasis on tele-health or e-mental health consulting; or the many meditations and other apps like Calm and Headspace, both preventive and curative approaches to mental health are moving online.
To understand how technology can help, let’s look at the various tiered approaches to mental health and wellness. At the most focused level are interventions to treat specific clinical/DSM disorders. These need to be very targeted and customized, and typically require extensive domain knowledge and expertise, and are best delivered by qualified therapists. The most prominent solutions here are tele-health sort of solutions that enable a marketplace and platform for connecting patients with psychiatrists and other therapists. The role of technology is typically restricted to matching interventions and therapists to clients though some ambitious platforms and apps have tried to deliver therapy using bots technology or at the very least, used technology / bots for diagnosis. Ginger.io is one example of a startup that is working at this tier. The client base is typically low, but interventions are longer lasting and revenue involved per client is more. Clinical psychology based approaches are the need of the hour in these remedial apps / solutions.
The second tier consists of interventions targeted at at-risk populations for which the definition can vary. Someone who is not currently suffering from depression, but has in the past; or has relatives who have suffered from depression, is a likely target. One typically picks a demographic subgroup and works with that to prevent full blown mental illness. A TransTech app / solution in this domain will focus on preventing depression; tackling anxiety; or ensuring better sleep. Calm app, that initially focused on sleep/anxiety, is perhaps the most well known app in this tier.
Lastly we have universal prevention based interventions that are applicable to all of us and which lead not just to prevention of mental illnesses, but also to increases in well-being. Many of these are steeped in positive psychology approaches though some CBT/REBT skills also come in handy. For example a very simple app that just helps you keep a gratitude journal is useful, not just in treating moderate to mild depression and preventing it, but also in increasing well-being in all of us. Headspace is one example of a meditation app focused on increasing wellness in all of us. The solution could also be focused on a practical domain, like HappyWorks which has universal interventions like strengths spotting and gratitude acknowledgement to increase well-being in the workplace. And then there are other apps like that for habit building like the Atom.
While many of us feel that TransTech is only about the third tier or universal, preventive mental health based solutions; actually well-being cannot be ensured or made sustainable if solutions at other levels of treatment and targeted prevention are not there. So we will look at investing and technology trends in all three tiers.
As per a blog post by What If ventures, Q1 2020 funding for mental health startups reached $462m across 30 transactions, compared with a full year 2019 amount of $750m. The startups that received funding included Headspace (universal prevention), Lyra and Modern Health (focused on a domain: work) and Axial Healthcare and Boulder (targeted addiction related remedial solutions). It is important to note that while money is flowing in, it’s not flowing indiscriminately: it is being channeled into the work domain (as more people are working from home and under stress in relation to retaining their pre-Covid level productivity); or the substance use domain (as lock-down is increasing the need of managing these issues); or tele-health solutions (with the wavering of HIPAA sanctions during the pandemic and a situation that is likely to continue).
Social Media use has gone up during the pandemic and many people who were previously not on Twitter or Facebook as examples, have joined these platforms or become active. This can be harnessed in well-being solutions. Many solutions try to match the personality of the user with interventions to achieve a fit and deliver precision behavioral interventions that are tailored to that user or demographic. The usual way to infer personality / demographic like age and gender is to ask questions at the time of on-boarding of the user or thereafter.
A non intrusive way to do the same is by analyzing the public tweets and status updates of users. Advanced AI/ML techniques can be used to determine the age band or gender; or personality traits of users; or even their happiness or depression/anxiety levels. The work done in Johannes C Eichstaedt’s lab is along those lines and ripe for commercialization.
Another indirect method of increasing happiness is by making people aware of their strengths and then encouraging them to use them more intentionally. While surveys are available to find out strengths, and some innovative apps like HappyWorks use social endorsements to figure out strengths, another easier approach is to mine through the tweets / status updates and figure out whether a person is low on hope and zest. Then, targeted interventions to increase hope and zest can be suggested to him or her. Again, this study by Eichstaedt’s lab shows that they have done some cutting edge pioneering work here.
So, we have all the pieces that are needed to build an app/solution that mines the tweets/status updates (with the user’s consent of course) and suggests targeted and personalized interventions. Ideally such a system should be able to detect when a person is likely to experience a dip in well-being, and what interventions are best suited to uplift him / her based on his/her disposition as well as his/her momentary state. A dream product would be one that would alert the user or other near and dear ones, of a risk of self harm and alleviate suicide by connecting to a compassionate listener or professional help based on the degree of need. Sometimes, all that one needs to prevent suicide, is the ability to reach out to a compassionate listener at the right time. Of course, much more work needs to happen before we can use techniques such as these in commercial products.
With mental health as the next looming crisis post Covid-19, and suicides and suicide attempts picking up, the need to go all out making transformative technology products is definitely there. Of course, there are multiple roads that lead to Rome We can alleviate suffering and increase well-being by using targeted interventions that are focused on those who are suffering from depression/anxiety and are vulnerable to self harm; we can also design unobtrusive solutions that keep monitoring their online activities and footprints to alert and provide support just in time. And of course, this clubbed with universal interventions to increase well-being would complete the ecosystem of apps/solutions that are needed.
We are upbeat about people using this crisis as an opportunity to build better and faster products to tackle well-being — we need those tools on a yesterday basis. We can either rise to the occasion and address the much needed demand for well-being solutions, using or creating the technology that is needed to do so, or we can keep wallowing in our misery. I guess the choice is as clear as day!