Digital Behavioral Health Tools Can Address Treatment Shortages & Accessibility-The HSB Blog 6/24/23
Our Take:
The integration of digital health solutions in behavioral health has the potential to reshape the care landscape by increasing accessibility, providing personalized treatment options, and facilitating early intervention and prevention. These technologies can not only address the shortage of treatment options but they can also empower individuals with behavioral health issues to actively manage their symptoms and improve their overall well-being. Digital health is a complement to traditional care rather than a replacement.
Key Takeaways:
One study found “no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores on standard assessments of depression or anxiety (BMC Psychiatry)
As of March 2023, 160 million Americans live in areas with mental health professional shortages, [and] over 8,000 more professionals [are] needed to ensure an adequate supply (Commonwealth Fund)
An estimated 21M adults or approximately 8.4% of U.S. adults had at least one major depressive episode (NIMH)
The percentage of need for behavioral services that is actually met nationwide is less than 30% (KFF)
The Problem:
For years there has been a shortage of providers and treatment options that address behavioral health needs. For example, according to a recent report from the Commonwealth Fund, “as of March 2023, 160 million Americans live in areas with mental health professional shortages, [and] over 8,000 more professionals [are] needed to ensure an adequate supply.” Moreover, data from the Kaiser Family Foundation estimates that the percentage of need for behavioral services that is actually met nationwide is less than 30% (27.7%) as of September 2022.
While historically it has been difficult to coordinate care between digital interventions and healthcare providers, because of the broader acceptance of telehealth during the Pandemic digital delivery of behavioral care has become more broadly accepted and is now seen as a way to address this care gap. However, as behavioral care moved towards digital delivery it became increasingly clear that ensuring effective communication and data sharing were essential to maximize its benefits. In addition, as we pointed out in “Integrating Telemental Health Into Primary Care Aids Diagnosis and Treatment-The HSB Blog 3/7/22” here, telebehavioral health “may allow for more accessible and affordable care with equal or better outcomes than in-person care, especially for diagnosis and treatment.” This is especially true in the most acute shortage areas which tend to be in rural care. For example, as noted in Digital health technologies and major depressive disorder, “telemedicine or care coordination platforms can help provide remote care to rural areas or hard-to-reach communities, thereby enhancing patient-provider collaboration.”
Moreover, although digital health has the potential to increase access to treatment for behavioral health conditions, disparities in technology access and digital literacy can perpetuate inequities. As noted in Facts & Figures: Mental Health in Rural America, “rural residents report difficulty accessing healthcare services and an absence of anonymity when seeking care in the South.” The article goes on to note that “a common sentiment among Southerners is that the prevailing stigma and conservative belief system in rural communities can hinder the search for health care.“ These disparities can be particularly acute for low-income individuals, rural populations, older adults, and marginalized communities. As a result, these populations may face even greater barriers in accessing and effectively utilizing digital health tools. Finally, given that digital telebehavioral health solutions collect what some would say is patients' most sensitive personal health data, their use and integration raises concerns about data privacy and security.
The Backdrop:
Based on data from the Centers for Disease Control (CDC), approximately 50% of Americans will be diagnosed with a mental illness at some point in their life and 1 in 25 Americans are currently living with a mental illness. For example, the National Institutes of Mental Health (NIMH) has found that “an estimated 21M adults or approximately 8.4% of U.S. adults had at least one major depressive episode (defined as “a period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities, including problems with sleep, eating, energy, concentration, or self-worth”). However, the widespread adoption of smartphones, high-speed internet, and digital connectivity has created opportunities for reaching individuals like those suffering from depression remotely and also provides a means to bridge geographical barriers.
For example, as noted in “Digital health tools for the passive monitoring of depression: a systematic review of methods”, “with the global trend toward increased smartphone ownership (44.9% worldwide, 83.3% in the UK) and wearable device usage …this new science of “remote sensing”, sometimes referred to as digital phenotyping or personal sensing presents a realistic avenue for the management and treatment of depression” as well as other behavioral health disorders.
Furthermore, the emergence of data analytics, artificial intelligence, and machine learning has the potential to enable a new modality of personalized behavioral healthcare approaches. By leveraging patient data, algorithms can help tailor treatment plans, predict risk factors, and optimize interventions for individuals with behavioral health conditions. As highlighted in a recent article in Scientific American entitled “AI Chatbots Could Help Provide Therapy, but Caution Is Needed”, "as an assistant for human providers…LLM chatbots could greatly improve mental health services, particularly among marginalized, severely ill people.” This is particularly true in terms of helping with the administrative burden where “programs such as ChatGPT could easily summarize patients’ sessions, write necessary reports, and allow therapists and psychiatrists to spend more time treating people."
Implications:
Digital health interventions can help address barriers to accessing mental healthcare, especially for individuals in underserved areas or with limited mobility. Remote platforms, telemedicine, and mobile applications provide convenient and accessible avenues for individuals to seek support and treatment for depression. For example, in an article entitled, “Comparison of in-person vs. telebehavioral health outcomes from rural populations across America”, the study’s authors found “There was no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores for either PHQ-9 (a standard assessment for depression) or GAD-7 (a standard assessment for anxiety)” leading them to conclude “no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person.”
In addition, digital health tools can enable efficient screening and early detection of behavioral health symptoms. Automated assessments, digital questionnaires, and mood-tracking apps can help identify individuals at risk, allowing for timely intervention and preventive measures to reduce the severity and duration of episodes in need of treatment. Digital health solutions can also help extend the reach of facilities and clinicians through such technologies as remote monitoring while wearable devices and mobile applications can track mood patterns, sleep quality, activity levels, and other relevant data. This information can support self-management strategies and help healthcare providers monitor progress, make informed treatment adjustments, and provide timely interventions as needed.
However, a note of caution is also warranted as the use of digital health in mental health care raises important ethical and regulatory considerations. Protecting patient confidentiality, ensuring data encryption, and implementing robust security measures are essential to build trust and maintain the integrity of digital health platforms for depression. While technologies and generative AI hold great promise in alleviating the shortage of practitioners, as noted in “AI Chatbots Could Help Provide Therapy, but Caution Is Needed’ an AI chatbot called Tessa, which was not based on generative AI but …gave scripted advice to users. Would sometimes give weight-loss tips, which can be triggering to people with eating disorders.” Although this is likely to improve as the technology improves, understanding and addressing nuances in treatment could be a key to the effectiveness of the technology. In addition, Safeguarding patient privacy, ensuring data security, and maintaining ethical standards in the use of AI algorithms and predictive analytics are critical to protecting the rights and well-being of individuals with behavioral health issues.
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