Contributor: Anne-Maree Cantwell, MD and MA’86, WG’86 from the Joseph H. Lauder Institute at Wharton
To learn more about Anne-Maree, click here.
With the Covid-19 pandemic, mental health problems in the U.S. have risen dramatically. Anxiety, depression, and substance abuse are now occurring at increasingly higher rates while at the same time there is a shortage of mental healthcare professionals.
What is a viable solution to delivering mental healthcare treatment to more patients with fewer providers? Can technology, with the use of the Internet and 5G wireless networks, help solve the problem? If platforms and apps offering remote services are an option to address the gap, are these digital solutions effective in reducing the severity of mental health disorders? What might be the role of artificial intelligence (AI) in bridging the looming gulf in supply and demand?
THE EVOLVING CRISIS
Approximately one in five adults in the U.S. experienced a mental health illness in 2019, and this has only been exacerbated by the Covid-19 pandemic. Yet more than half of these adults do not receive any mental health treatment. The situation is equally as dire in youth aged 12 to 17. While 15% of youth have experienced a major depressive episode in the past year, 60% of this group do not receive mental healthcare. Mental health disorders are the most common in those identifying as being from two or more races, yet racial minorities have less access to mental health services than whites, and the quality of care is usually not as good.
Simultaneously, mental healthcare professionals are burning out due to the ever-increasing workload, and the problem is even greater in rural locations. In addition, 60% of all psychiatrists are over 55 years of age and will retire in the next 10 years. An alarming 60% of the approximately 3,000 counties in the U.S. have no psychiatrists at all, and many are in rural areas.
PROMISING
Can technology bridge the divide between mental health needs and a lack of qualified providers? How effective are these technology solutions beyond their face value promise?
With the advent of high-speed Wi-Fi and fast wireless networks, along with the ubiquity of computers, tablets, and smartphones, many mental health digital platforms can now offer services remotely. Companies such as Ginger and Talkspace offer remote mental health counseling via live video sessions and/or asynchronous texts done via a smartphone. Asynchronous care involves an audio, written, or video text sent where the provider responds usually within 24 hours.
Not everyone has the financial means to engage in traditional or even online therapy, and it can take weeks to be seen in person by a therapist. Furthermore, some people feel a stigma around getting the mental health support they need. As a result, a number of apps and platforms have been developed to provide mental healthcare by non-traditional means that don’t require a live provider.
Two smartphone apps, Wysa and Woebot, use artificial intelligence and natural language processing (NLP) to deliver cognitive behavioral therapy (CBT) for depression and anxiety.
Bezyl, a smartphone app, encourages cancer patients and military veterans to develop spheres of support to help with mental health. TAG is a computer platform where consumers with mental stressors can watch others talk about their own struggles and listen to how a psychologist might help them solve those problems. Online communities also exist to provide support, and multiple other mental health apps are addressing the growing need for mental health support.
EFFECTIVENESS OF ONLINE TREATMENTS
A meta-analysis of 17 studies in 2020 comparing online live cognitive behavioral therapy (eCBT) with in-person CBT for depression revealed eCBT was at least equally effective as face-to-face CBT in reducing depression severity. Participant satisfaction was equal between the two, and eCBT proved to be cheaper.1
Regarding other mental health disorders, in 2018, 20 studies were pooled showing there was no difference in eCBT when compared with in-person treatment for disorders such as depression, anxiety, panic disorder, phobias, and some somatic disorders including fibromyalgia.2
The cost advantages for eCBT come in decreased costs for the patient in travel time and childcare costs as well as less absenteeism from work. Provider advantages include decreased commuting time and expense when working remotely. Missed patient body language cues was one provider disadvantage, however.
On-demand video visits have the added advantage of decreased time to accessing care, as wait times to be seen in person can be weeks long. Follow-up visits were more likely to happen with online care due to increased convenience and lower cost.
What about asynchronous care? In one large study3 with over 10,000 enrollees, asynchronous daily communication with a mental health provider via audio, video, or written texts suggested being effective in reducing symptoms in over two-thirds of patients with acute anxiety or depression. People with chronic anxiety or depressive symptoms did less well, however, and no control was provided in this study.
The effectiveness of artificial intelligence driven apps such as Wysa and Woebot, as well as online communities for depression and anxiety, needs further evaluation.
PROVIDER SHORTAGE, AFFORDABILITY, AND INCLUSIVITY
Online telehealth visits can be shorter than in-person visits, allowing a single therapist to treat more patients. The patient-to-provider ratio can be further increased by the use of asynchronous texts, as one therapist can treat several patients simultaneously. AI-driven apps have options of no live therapists at all, offering the greatest promise of leveraging technology to treat mental health conditions.
All the above options can increase access by not requiring health insurance and by being more affordable for underserved communities.
MOVING FORWARD
The imperative of reinventing how we address mental health is unavoidable if we are to close the pernicious gap between high demand and a shortage of mental health providers. While online platforms have shown efficacy in treating mental illness, many of these options still require live providers.
If we are to provide full access to care for all those suffering from mental health conditions, AI must be fine-tuned, and its efficacy shown in treating at least mild conditions of depression and anxiety. AI-driven apps have the added benefit of making treatment more affordable and accessible, as only a smartphone and cellular connection are required. Technology does hold the promise of solving the mental health treatment gap, with AI offering the greatest possibility of making this a reality.
Contact Anne-Maree at: [email protected]
- Luo C, Sanger N, Singhal N, Pattrick K, Shams L, Shahid H. et. al. A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis. eClinical Medicine, Part of THE LANCET Discovery Science, Vol 24, 100442, July 1, 2020.
- Carlbring P, Andersson G, Cuijpers P, Riper H, and Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther. 2018 Jan;47(1):1-18. doi: 10.1080/16506073.2017.1401115. Epub 2017 Dec 7. PMID: 29215315.
- Hull TD, Malgaroli M, Connolly PS et. al. Two-way messaging therapy for depression and anxiety: longitudinal response trajectories. BMC Psychiatry20, 297 (2020). https://doi.org/10.1186/s12888-020-02721-x