The quality and resources available to mental health care and treatment in the United States has been on the downswing since the 1980s. It started with the closing of government-run state psychiatric hospitals (putting our most at-need patients at risk, and often, on the streets), without the government offering a comprehensive network of community-based care to take their place.
Then managed care — companies driven by profit and greed — came along and mid-level managers with no mental health background started dictating exactly what kind of mental health treatment was appropriate to which patients.
Now we live in a time where venture capital (VC) firms believe that technology can magically solve many of the ills connected with receiving high-quality, timely mental health care. But of course, like the managed care companies that came before them, many too are simply driven by potential profits and their return on investment, all the while offering the “solution” of lower-quality, shoddier care.
Adam Seabrook, apparently one such venture capitalist, decided to write about all the problems with people seeking mental health care in America over at TechCrunch, a technology blog:
- 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
Let’s look at these four things to see if they really are the kind of problems that Seabrook describes in today’s world. And, more importantly, whether technology and apps are the best solution to these problems.
We stigmatize people who seek treatment
Great people like Rosalyn Carter (working on behalf of the Carter Center’s Mental Health Program in Atlanta), and organizations like Mental Health America and NAMI, having been working for decades to help reduce the stigma associated with mental health issues. Newer organizations, like Glenn Close’s Bring Change 2 Mind, have also invigorated the conversation.
Knowledge helps defeat stigma more than anything I know. Knowledge to populations (not just individuals) is provided best by websites and apps that disseminate factual information about mental health issues (like us!). If you want to address the root of the problem, you have to look to what’s been working pretty-darned well now for decades.
Are we “there” yet? I’d argue that while we still have a ways to go, we’re so much closer to the goal of eradicating prejudice and discrimination based on mental illness than ever before, due in great part to the Internet and technology. But if you listened to the way Seabrook tells it, the past two decades have seen little change on this issue. Nothing could be further from the truth.
How does technology helps? It allows you to avoid seeing a mental health professional directly, instead reinforcing the shame of the condition — that it’s not something you should seek out regular treatment for.
Clinicians don’t have effective diagnostic tools for many conditions
This is simply a falsehood. Clinicians have effective diagnostic tools for every mental health condition that exists. In many cases, they’ve had such tools for decades. Now, one could argue whether such tools are as easy-to-use or as awesome as they could be. But they clearly exist, as the hundreds of psychological assessment measures — most with significant research backing — make clear.
It’s a shame Seabrook thinks otherwise. And why I cringe when I see a well-meaning VC finance guy write such falsehoods, as it promotes misinformation about mental illness — furthering discrimination and stigmatization of it. (As an interesting aside, did you know that most medical diagnoses do not have a definitive lab test used as a diagnostic tool for that diagnosis?)
Technology only helps in that it streamlines and puts diagnostic data directly into a database or electronic health record. It doesn’t result in more accurate diagnoses, and so it doesn’t really help people with mental illness one iota.
Practitioners are capable of addressing less than half of the current need
Assuming a theoretical world where 100 percent of people sought out services 100 percent of the time, every single year, yes, that may be true. But it has nothing to do with the real world in which we live in.
There are more practitioners today offering psychotherapy services in most markets than there is demand for them. Ask 100 practitioners, and the vast majority of them will be accepting new clients. The one case where this is not true are psychiatrists. We have been experiencing a shortage of psychiatrists for years now — maybe more than a decade already — and that’s not a problem readily solved except by providing more incentives for doctors to specialize in this area of medicine while in medical school.
Another chokepoint that promotes a shortage of care is because of how insurance companies staff their provider panels. In an effort to keep costs in check (or, as some would say, “keep profits rising”), many companies artificially keep their provider panels understaffed. This not only ensures they have a way of rationing care (which is illegal), but also keeps clinicians on their panels well-booked. It’s more of a regulatory problem — one that could be more readily solved by better policing of these companies.
Help is prohibitively expensive for many
Indeed, if you have to pay out of pocket for anything, it can become expensive. That includes any type of app or technology service too, since most insurance companies don’t cover the kinds of new apps and services that Seabrook talks about in his article (with one or two notable exceptions).
But compared to typical cancer treatments, mental illness treatment is downright affordable. It all depends on what you’re using as a yardstick (Seabrook doesn’t say). It’s a mystery how technology helps this issue much, when a minute of a therapist’s time costs whatever it costs — whether you see someone via video or face-to-face. Unless, of course, technology offers you some lesser treatment option that isn’t as good as a real-life psychotherapy session.
Solving the Real Problems Facing Mental Health Treatment in America
Dear Adam Seabrook, I know your heart is in the right place in writing such an article. But before becoming a shill for this space where you’re just trying to help sell the value proposition of this market, please consider getting a reality check from actual mental health professionals, advocacy and policy people, and front-line clinicians. We see the problems in the real mental health care system (not in the Silicon Valley or New York City bubbles). Many, many organizations and thousands of really smart people have been working tirelessly to address these problems head-on for many years, through changing the system and the way that people talk about mental health issues.
This is not a “sector primed for disruption.”1 Internet-based cognitive behavioral therapy — which you positively gushed about in your article — has also been around for nearly two decades. And guess what? It has some significant hurdles to overcome — hurdles that miraculously were never mentioned in your article.
Because if real behavioral change were as simple as reading a few lines of text in an app and charting your progress (with occasional motivational messages to keep you going — yay!), self-help books would’ve solved everyone’s problems 30 years ago (or, more recently, any one of the thousands of existing mental health apps). Real behavioral change isn’t easy. And while I appreciate that now many app developers have acknowledged that (because their utilization rates of their apps remain embarrassingly low after the initial download or a single session) and added a human coaching component onto their service, it feels like the band-aid, lowest-common denominator approach that it is in most cases.2
Technology can’t really solve any of the problems you identified, and likely won’t make much of a dent in the real problems facing people with mental illness. Why? Because people want human connection in order to make real changes in their life. And that’s best delivered in the high-quality setting it traditionally has been delivered in — face-to-face, in a doctor’s or therapist’s office.3
Mental Illness Deserves the Same Respect, Resources as Physical Disease
After all, we wouldn’t be looking to “disrupt” cancer treatment with less-than the gold standard of treatment for cancer. So why would we find it acceptable to try and help people with mental illness with less-than the gold standard of treatment for mental illness?4
More than seventeen years ago in 1999, the U.S. Surgeon General released a ground-breaking report on mental illness. In it, David Satcher, M.D., Ph.D. wrote:
Considering health and illness as points along a continuum helps one appreciate that neither state exists in pure isolation from the other. In another but related context, everyday language tends to encourage a misperception that “mental health” or “mental illness” is unrelated to “physical health” or “physical illness.” In fact, the two are inseparable.
I share this insight to remind us that the idea that mental illness is just as important as physical illness is neither a new nor ground-breaking idea; most educated people accept it as fact today.
Let’s now move on to the next stage: treating mental illness with the same high regard — with respect and resources — as we do physical illness. Let’s not just unceremoniously shove mental illness onto unlicensed “life coaches” or un-researched apps, any more than we would push cancer treatment onto unlicensed professionals or apps! Let’s not “solve” the problem with technology fixes, but actual fixes to getting people the high quality, gold-standard care they both need and deserve.
Read the original article: Technology and today’s vast and immensely underserved mental health population
Footnotes:
- That is a line I pitched myself in the year 2000 when making the rounds for an innovative e-therapy company that offered video chats with therapists.
- To better understand the real demand and challenges in this space, ask your startup or app developer how many customers complete: just the download; a single session or module on their app; more than 10 sessions; more than 20 sessions. If the more than 20 sessions number — the only metric of value — is greater than 3 percent, you might have yourself a winner; otherwise the company is going nowhere fast.
- It can also be delivered by a video app or the like, but that isn’t going to solve many problems, since video takes the same exact amount of time as a face-to-face interaction does.
- To me, this is just another example of inadvertently reinforcing the stigma associated with mental disorders. If you wouldn’t suggest these kinds of “solutions” for a physical disease, then please don’t try and pawn them off on people with mental illness.
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