In December, The New York Times asked 1,320 mental health professionals to share how their patients are doing as the United States moves into the third year of the pandemic. The responses provided insight into the increasing crisis, which is being described by some as a “second pandemic.”
Earlier in December, U.S. Surgeon General Vivek Murthy issued a public health advisory on mental health challenges that youth are facing, painting a picture of significant concerns that were developing even before the COVID-19 pandemic, concerns that are being made worse by the pandemic. Surgeon General Murthy warns of the need to fight this other growing health crisis even as we are fighting COVID-19.
The pandemic brought mental health into the center of the global conversation. The state of mental health services in the United States is characterized by increasing numbers of patients who are in distress, practitioners being overwhelmed by requests for support, and increases in waitlists. Significant demand is not being met for behavioral healthcare services in response to the pandemic. There aren’t enough therapists to help everyone and therapists themselves are experiencing burn out. The pace of change in mental health and behavioral health has accelerated, from growth in telehealth visits to the increase in digital therapeutic systems.
How we deliver mental and behavioral health service will require improvements to meet these growing needs. Given the significant growth in people suffering from depression, anxiety and other mental health problems, therapists are in need of tools that enable them to objectively assess the behavior of their patients. There are an increasing number of digital mental health tools that promise solutions through a range of methods ranging from AI therapy chatbots, to increased telehealth availability, or digital therapeutics. Few of the solutions are based on real-world evidence and sound scientific research in a clinical setting.
Generally speaking, practitioners rely on their years of experience and instincts when working with patients and clinical decisions may be based on intuition or other subjective factors. Systematic objective measurement has not traditionally been available to asses patient progress or response to a particular intervention. Capturing what goes on between appointments is even more challenging, with practitioners relying primarily on the patient’s reporting of their own mental health.
Subjective assessments and patient reported outcomes are difficult to scale. Without an objective form of measurement, it is difficult to measure progress in at a scale that can meet the size of the need.
Lloyd Price, tech entrepreneur and CEO of Stealth Health, has been cataloging the development of digital health “hype cycles” for years based on a model developed by Gartner. Digital mental health is subject to the same kind of hype curve stages, moving from a technology trigger to a period of exaggerated expectations (and claims from tools) to disillusionment, and finally to a more stable plateau of productivity.
The lasting effects of digital mental health solutions will likely be less than the exaggerated claims being made by tools trying to capitalize on the significant need. The plateau of productivity tends to stabilize around more likely levels of aid that can be provided by digital solutions. The biggest value that digital mental health solutions can provide are benefits around measurement, practitioner enablement, efficiency and potential for scale.
Continuous behavioral health measurement can help in evaluating therapeutic approaches to objectively evaluate claims and measure real-world patient results. It can enable practitioners to better care for their patients, and it allows for new efficiencies and can be scaled using the smartphone that most patients already have.
Due to the pandemic, many practitioners have increased their use of telehealth and patient support apps to care for their patients. There has been some resistance due to concerns about privacy, safety, and how telepsychiatry fits into the clinical workflow.
Beyond the growth of virtual care, much of behavioral health care and therapy has not changed dramatically. Technology accelerated the growth of telemedicine and virtual care, but there is room for improvement in the use of digital technology to objectively assess patient condition and behavior. Measurement in behavioral health, if done at all, has been based on subjective self-reporting that only captures a moment in time.
Continuous behavioral health measurement can provide ongoing real-world evidence of patient behavior based on years of evidence. For behavioral health care and psychotherapy to scale to meet the needs of the moment, it needs this kind of innovation in how we measure mental health. That innovation must be led by the science, based on real-world clinical practice and digital phenotyping research. Patient privacy must also be at the heart of the process. Technology can provide valuable measurement to the practitioner and patient while also carefully respecting the patient’s data privacy. By providing safe, reliable scientific measurement give practitioners insights that can transform their care services.
Continuous behavioral health measurement provides objective assessment of patient behavior and activity as a basis for care and evaluating deterioration or improvement as a result of a therapeutic approach or intervention.
Technology also allows for these interventions in the moment, as part of the patient’s everyday life. Digital platforms can provide such personalization to enable better holistic mental health support. By using real-time objective measurement of behavior these interventions can be personalized to occur “just-in-time” at the moment of need for that particular patient. By personalizing care, practitioners build a stronger therapeutic alliance and bring therapy out of the office and into the patient’s daily life.
Objective assessment—through continuous behavioral health measurement — also provides the basis that allows practitioners to match the level of care provided to the severity of patient distress. Practitioners are enabled to provide services so that the most effective and least intensive treatment is delivered to patients first with services ‘stepping up’ to more intensive and specialized services if clinically required.
This stepped-care model of behavioral health services is based on international evidence-based clinical guidelines for the effective delivery of care. Continuous behavioral health measurement has been the missing piece. With objective continuous measurement stepped-care can be scaled to enable practitioners to more effectively meet the needs of the crisis at hand.
Digital solutions like Vira provide continuous behavioral health measurement to enable practitioners to be more effective. Digital tools will not replace clinicians and their expert care, but clinicians that use digital tools skillfully will replace those who do not. Providing the right level of care based on the real-world objectively measured levels of mental health distress gives practitioners the ability to be more efficient and more effective.
By providing practitioners with continuous behavioral health measurement and personalized innovation tools, we can enable them to be more effective and efficient, we can begin to meet the mental health needs of millions of people. Subjective patient-reported outcomes should be combined with objective measurements for more complete real-world evidence. By making these tools universally available we can change the state of behavioral health at this critical time, supporting practitioners and behavioral health systems.
Vira is improving mental health through continuous objective measurement and personalized intervention. To read more about how Ksana Health can help you implement continuous behavioral health measurement in your practice, please read more about Vira and schedule time for a demo.
22 January 2022
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