Thoughts on the Mental Health Space

In this discussion, we explored the evolving landscape of mental health technology, addressing its diverse areas, including preventive care, wellness, suicide prediction, and digital therapeutics. Despite significant pandemic-era investments, many solutions fell short due to misaligned incentives and hasty implementations, highlighting the need for reassessment. Key issues include unclear funding responsibilities, misaligned financial incentives for therapists, and a troubling trend of self-diagnosis. Promising solutions involve low-cost, integrated digital tools focused on health outcomes rather than engagement. Successful examples like Grow Therapy and Koa Health showcase potential if given adequate time and capital, though the industry faces obstacles like the short-term focus of the startup ecosystem. For innovators, the advice is to improve existing systems, prioritize sustainable health outcomes, collaborate with clinical experts, and seek long-term impact partners, offering a roadmap for meaningful change in mental health care.

Interviewer: What are your thoughts on the current trends in mental health technology? How do you feel these trends are shaping the future of mental health care?

Brody: The mental health tech space covers such a wide range of topics like Preventive, Wellness and Mindfulness, Suicide Prediction technology, Digital Therapeutics (DTx) and more - my thought is that it's an incredibly interesting space, but struggles to find truly impactful solutions because of misalignment in incentives within the United States. Unfortunately, we are also seeing a "mental health hangover" from the Pandemic, where multiple companies raised an incredible amount of money and sold solutions to buyers who were in a vulnerable situation of "something is better than nothing" - and now 2 years post pandemic, these products haven't helped or improved overall mental health at all. It's not all doom and gloom though - there are incredible companies making some incredible strides into providing better access to mental health, and even using technology to identify and stop suicide attempts. There is some really amazing things happening - as an industry, we just need to reassess what/how to invest in moving forward.

Interviewer: You mentioned the misalignment of incentives in the mental health tech space in the United States. Can you elaborate on what specific misalignments you see and how they impact the development and implementation of effective solutions?

Brody:  Sure, let me try to give some highlights and then if we need to go deeper we can: First and foremost, there is a misalignment (or no alignment, whatsoever) on who is responsible for paying for mental health. This is true for treatment, like therapy or psychiatry, but it's even more loosely defined when it comes to preventative mental health and mental health education. Some say it's the insurance companies, others say it's employers, most agree that the government should have a part in it (complicated), but at the end of the day most ends up coming Out of Pocket from the person who needs or wants it. Secondly, we speak a lot in the industry of the clear "supply and demand" problem. X number of therapists cannot see Y number of patients who need therapy. While that is certainly an issue, it is made significantly worse by the financial incentive structure of mental health in the US. For example, therapists only make money when they are seeing a patient - IF the patient is submitting a claim through insurance, there must be a diagnosis attached to that claim. The therapist is then incentivized to continue treatments regardless if that is the right thing for the patient at that time. -- I'm not blaming the therapists, but it's not financially advantageous for them to recommend a patient stop therapy. Third, is a misalignment around diagnosis, who is qualified to give a diagnosis, and unfortunately a new trend in self-diagnosis (this is a culture issue). In the interest of "ENDING STIGMA" around mental health I believe our society accidentally made it "cool" to have a mental health issue. That's a strong opinion, but I see it all the time. When I was on dating apps it was all over... "looking for someone who goes to therapy" or "must value mental health". While I am someone who loves to see and hear people say things like that, I definitely do not believe it should be a qualifier for a first date. In the age of TikTok Therapists, we're in a dangerous position where unqualified people are influencing others (maybe with good intentions) to seek help or a diagnosis for basic emotions (sub-clinical) rather than actual symptoms that may indicate a clinical issue(s)

Interviewer: That's an insightful response. Considering these significant misalignments in responsibility, financial incentives, and diagnosis within mental health care, what changes or solutions do you believe could address these issues effectively? How can the industry realign to better serve those in need?

Brody: I believe that there are solutions out there - I will highlight the ones that don't have to do with government intervention (which I think is necessary, but incredibly slow and will vary on the administration). Let's break this down into one of my favorite formats of giving information. Issue, Action, Value.

Change/Solution 1: 

• Issue: Mental Health Treatment can be expensive and is often the responsibility of the person experiencing it, which leads to inaction or looking for cheaper, not clinically validated solutions.

• Action: At Koa Health I think we're building a piece of this, but it's a systematic change. I truly believe that people want to invest a little in their mental health and wellbeing. I propose a low-cost comprehensive digital solution that is purchased by the consumer that tracks mental health overtime and gives personalized recommendations of education and content (rooted in CBT). The caviat here is that the digital solution should not be it's own application, but instead - numerous apps that are add-ons to other things that users use on a daily basis (productivity tools, social media, TV, Phone OS's, etc). This is the front gate to a Stepped Care model that is part of the US Healthcare system - which is where therapy, peer-to-peer solutions, and counseling comes into play. These interactions would be 90% subsidized solutions based on benefits you have from an employer, the government, or your insurance provider. I think one of the critical pieces of a mental health solution in the US is to include therapists in the app. Adding the ability for a therapist to manage and recommend content to their patients, be an active participant in their patients recovery, and more. I'm not exactly sure how I would do this, but in my research it's a key piece that's currently not being leveraged by digital solutions (that I know of). I could go on for a long time with different things that we could do in the US, but it would be too much to write and read within the time I have.

• Value: Users need to stop thinking of Mental Health as a component of their wellbeing, and instead start embedding it into how they think about their life overall. This is only possible if we stop building point solutions, and start embedding it into people's daily flow.

Change/Solution 2:

Investment in Mental Health needs to be for Health Outcomes, not Engagement.

• Issue: We have a problem. How many times have you showed up to a virtual meeting but learned and remembered absolutely nothing? Are you fluently speaking the language you've been learning for 734 days straight on DuoLingo? Engagement metrics are GREAT for measuring whether people find your content and tools useful, BUT... is that really what Mental Health products should be aiming for?

• Action: Investment (and even buying) mental health solutions should be based on Health outcomes, and not the number of times someone logs in or engages with the app. Mental Health is part of our lives, but it doesn't mean that we need to use an app or tool everyday to manage it. In fact, it's the opposite - the goal should be that the user needs apps less and less as they progress in their mental health journey.

• Value: Product teams can stop designing products specifically for engagement, and focus on what it truly takes for someone to increase their mental wellness. Sometimes that might be increased engagement, but that's not the North Star Metric PM's should be striving for. I have more solutions, but I'm a bit tired of writing to be honest.

Interviewer: Those are some well-thought-out solutions. You mentioned the importance of embedding mental health into daily life and focusing on health outcomes rather than engagement. Could you share an example of a digital tool or app that you think is doing this well, or one that has the potential to? Why do you think it stands out?

Brody: I really love the potential of Grow Therapy. I think the way they started attacking the mental health challenges in the US was really smart. They started by providing tools for therapists to help manage their practices, and then once they had the trust and the network of therapists they have started to expand. Where they go with it is yet to be seen but I really love the way their Product Team is thinking about things. I think one unfortunate story is Headspace/Ginger. Their product is actually really good and close to what I think can truly move the needle, but they need a full rebrand and to kill the Headspace brand. That will never happen because they probably have a lot of sunk-cost and confirmation bias in the brand, but it got too watered down when they were B2C during the pandemic. And lastly, I'm certainly bias, but the work we're doing at Koa Health is aligning with the vision that I'm seeing needs to happen - but whether the company can go fast enough, and have the capital to truly make the vision a reality within the timeframe necessary (sub-18 months in my opinion) is an open question. Our model is based on Stepped Care 2.0, where users are assessed and routed to the lowest intensity care that matches their symptoms, but then always gives the choice to step up or down in intensity of care at anytime. This to me is what is needed in a digital format to improve health outcomes and lower overall mental health spend - but a lot needs to change/happen in order for that to occur. Too much to add here.

Interviewer: You’ve mentioned several promising companies and approaches. With the potential in mind, what do you think are the biggest obstacles these companies face in successfully implementing their visions? How could these obstacles be addressed?

Brody:  Time and capital. We have a significant mental health problem in the US, and while there is already a lot of capital being pumped into the industry, most are going to companies that are looking for quick wins and not long term impact. Unfortunately though, the other barrier is time. None of these solutions are "quick win" or "financially sustainable" in the short-term. People need to be thinking about playing the long game (15-20 years) but the startup ecosystem isn't built for that. Meanwhile, the problems are getting worse (and different) with social media and other products that are likely doing more harm than good, which constantly changes the scope of the companies trying to create meaningful impact. The industry is feeling a bit like a hampster wheel at the moment.

Interviewer: You mentioned the need for long-term thinking and sustainable impact. What strategies do you believe could help mental health tech startups navigate the pressure of short-term financial sustainability while working towards long-term solutions?

Brody:  I really wish I had a good answer for this. I need to think about this more deeply before I answer here. Maybe we can do another post around this later

Interviewer: Absolutely, we can revisit that topic later. To wrap up, based on your experience and insights, what advice would you give to someone looking to innovate in the mental health tech space? What key principles should they keep in mind to ensure their solutions are impactful and sustainable?

Brody: In order to innovate in the mental health space I think people need to really look at "how are things being done today" and work on improving those systems overtime rather than starting with "how can I improve the mental health of users". To me, it's the only way to sustain a business that will survive long enough to make the true impact and innovation we all want. Be ruthless about prioritizing health outcomes and sustainable behavior change over engagement and short-term metrics. Most importantly - find others who are truly in this for the long-run regardless of money or financial success. Lastly, and I can't say this enough, it is imperative that digital expertise MUST be paired with clinical expertise. If you have an idea, explore it with a clinician with experience standing up clinical services.

Interviewer: Thank you for sharing your insights! Here’s a summary of your advice for those looking to innovate in the mental health tech space:

• Focus on improving existing systems over creating new ones from scratch.

• Prioritize health outcomes and sustainable behavior change rather than engagement metrics.

• Seek out partners who are committed to long-term impact.

• Ensure digital solutions are developed in collaboration with clinical experts.

These principles will help guide the development of impactful and sustainable mental health tech innovations.