Technology and today’s vast and immensely underserved mental health population

Someone in your life is suffering from a mental disorder right now. You may not know it, but it’s there.

Indeed, one in five adults suffers from a mental disorder.

Society has trained us to believe mental illness is something to be ashamed of, so a majority of the afflicted hide it and go untreated. Also, patients are often perceived as being dangerous or incompetent, with little hope of recovery.

I’d like to say we’re becoming more accepting as a society, but pop culture examples to the contrary aren’t difficult to find — the newest song from Drake, “Two Birds, One Stone,” is critical of fellow rapper Kid Cudi for seeking treatment after admitting to feelings of depression and suicidal thoughts. Even the powerful and revered Tony Soprano had to hide his psychiatry appointments from his friends and family. There are other examples, but you get the idea.

On top of the stigmas we’ve created, we’ve also constructed a healthcare system incapable of treating all our patients because of capacity and cost constraints, favoring clinical solutions for more traditional health concerns, such as cancer and heart disease. It’s time to recognize that depression, anxiety, bipolar disorder, schizophrenia and other mental health conditions are every bit as serious and debilitating as physical conditions, and address the inadequacies in the medical community’s approach to treating them.

We’re leaving 50 percent of people without options

To put the problem in perspective, consider that 18.5 percent of American adults suffer from some form of mental illness. That’s nearly as many people as heart disease (11.5 percent) and cancer (8.5 percent), the two leading causes of death in the United States, combined. Imagine the public uproar if 50 percent of heart disease and cancer patients couldn’t find treatment. That’s what mental health patients face. More than half go untreated or undiagnosed, leading to nearly $200 billion in lost earnings and productivity for employers, and, far more importantly, more than 37,000 suicides every year. We also spend $200 billion each year on treatment for the half of the patients who can actually find it. The scope of the problem is immense, and we’ve failed this population in nearly every critical way:

• We stigmatize people who seek treatment
• Clinicians don’t have effective diagnostic tools for many conditions
• Practitioners are capable of addressing less than half of the current need
• Help is prohibitively expensive for many

What’s particularly distressing about the lack of access to care is how effective treatment can be — up to 90 percent of people who receive treatment experience an improvement in their symptoms. Treatment works, so we need to do better at delivering it. We at B Capital believe now is the time for digital health companies to lead the charge in finding a solution.

The time is right for innovation and improvement

The upside to our previous failings in mental health is that it is a sector primed for disruption. The U.S. market is large, but the problem is global; the number of afflicted and untreated patients worldwide follows closely in line with the percentages here in America. That means there are hundreds of millions of patients without access to care and traditional forms of treatment (i.e. face-to-face therapy) that can’t realistically or effectively scale up to meet this need. An alternative must be found.

We think technology will be a critical component of the solution — and a great deal of that technology already exists. Telemedicine is an effective tool for expanding the reach of traditional practitioners to treat patients in underserved areas. Digital therapeutics have long failed to deliver on the hype of better outcomes and lower cost, but, recently, treatments like internet-delivered Cognitive Behavioral Therapy (iCBT), which generally consist of self-help texts, homework assignments, queries and guidance by an online therapist, have been shown to deliver positive results for conditions ranging from social anxiety to depression to PTSD.

New analytic tools can sift through mountains of data to find signs and symptoms unseen by doctors. Digital health can dramatically change the way we diagnose and treat patients, and it can allow us to do it at a fraction of the cost. We’re not the only investors who have taken notice; the last 18 months have seen a flurry of investment in the space:

There were even clear regulatory tailwinds in favor of better care options prior to the presidential election on November 8. The ACA, for example, included mental health treatment as an essential benefit required to be offered by health plans. While President-elect Trump had been adamant his first order of business would be to repeal Obamacare, he’s since softened his stance and said certain elements of the ACA might remain in place (see the recent article by Gavin Teo). Regardless of the regulatory environment, we believe low-cost treatment options delivered in a manner that expands the capacity and reach of existing provider networks will find tremendous success.

The solution? Improved access to quality care

The dynamics of the mental health market are complicated and the needs are many. Practitioners need better tools to diagnose patients both in and out of traditional care settings. Insurers need clinically validated products that deliver results matching those from face-to-face therapy. Individuals need a way to eliminate or circumvent the stigma associated with seeking care. The cost of treating a patient needs to come down dramatically. But the market demands are indeed abundant and the conditions are ideal for innovation. So what will it take to win? In short, improved access to quality care.

The good news is there are clear signs of progress. Researchers at Northwestern University have developed an app called Purple Robot that tracks your movements and phone usage looking for signs of depression. SilverCloud Health delivers patient recovery and engagement rates on par with traditional face-to-face therapy. Ieso Digital Health allows patients to text in real time with their therapist semi-anonymously from anywhere, helping to reduce and eliminate stigma. Joyable, Lantern and SilverCloud use one-to-many delivery models with online tools and content to expand the capacity of existing mental health practitioners and reduce cost.

This progress gives cause to be optimistic about dramatically reducing the number of untreated patients as quality improves and adoption grows among payers, providers and consumers.