​A Global Access Solution to the Trillion Dollar Mental Health Crisis

Poor mental health care access is one of the biggest contributors to the worsening world mental health crisis. The evidence is stacking up, where mobile health (mHealth) solutions in augmented mental health platforms hold the greatest potential to release the supply-demand bottleneck, effectively and affordably opening the floodgates to mental health care access on a global scale.

Mental Health Care Access for Patients and Primary Care Providers is Unacceptably Poor
The World Health Organization (WHO) announced that depression is the leading cause of disability worldwide, amounting to an estimated global cost of $1 trillion, equivalent to WHO estimates of costs of cancer. Continuing with current access rates and models of care, economic and mental health repercussions are projected to rise many times over in the next 30 years.
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Beyond substandard access to mental health care services by patients and general practitioners for referrals are largely universal mental health care access barriers — a handicapping characteristic of conventional healthcare systems around the globe that is stagnating the mental health care industry. Means to rapidly access mental health services are essential for both primary care providers and their patients.

World-over, the current mental health access stats are unacceptably poor:
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• Mental health care provider shortages: High-income countries like the US have shortages of 1000s of mental health care professionals even in meeting very basic provider rations of 30,000 to 1. Meanwhile, low-middle income countries have an estimated shortfall of over one million health specialists. Moreover, the current high cost of care with current models means that social workers, psychologists, and psychiatrists are near non-existent outside of higher-income countries.


• Low access rates and long wait times: In many countries, research suggests that the majority of network psychiatrists are unreachable or unable to schedule new appointments when patients call, where waiting for an appointment often takes weeks, and the calls do not result in an appointment. For instance, Washington state should arguably have one of the best networks in the US, yet the latest research reported average wait times of 19 days, with only 7% of callers able to make an appointment. Meanwhile, research on mental health referrals from primary care (including research in Australia, Europe, Canada, Asia, South America, and the US) has confirmed that some of the longest specialist wait times have been observed with psychiatrists and psychologists, where referrals are frequently rejected altogether.

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Brute force strategies to increase the numbers of professionals in the market as is standard of old models of care cannot meet mental health care access needs realistically or effectively–new augmented mental health models of care are needed that make the most of technology in order to rapidly close the gap. Without upgrading and modernizing models of mental health care that take full advantage of mobile technology, there is only so much that legislative changes can do to substantially improve mental health access and the associated costs.

Augmented Mental Health: The Policy Strategy of Choice for Rapid Improvement to Mental Health Care Access

Whether via a tablet, computer screen, or mobile phone, using mHealth platforms literally provides access to mental health care, advice, and therapy at the touch of a button. Research supports that eTherapy (in the form of mental and behavioral mHealth interventions and communication) and eConsults (for primary care providers obtainment of mental health specialists’ input) are choice policy strategies, facilitating rapid access to mental health professionals and mental health care without necessitating a costly face-to-face visit.

The effectiveness and utility of these mHealth telepsychiatry services can be maximized by integration with the latest technological development: advanced emotion recognition for objective, real-time mental health monitoring. Termed augmented mental health systems, incorporating emotion recognition into mHealth platforms permits a previously impossible and unparalleled level of personalized intervention and access to care for immediate and early intervention.
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The features of augmented mental health systems that improve mental health access include:
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1. Mental Health Monitoring
   Remote monitoring of the patient using wearable technology where advanced algorithmic processing of biosensor-derived physiological signals is currently being used to accurately and objectively record the wearer’s emotional state in real-time.
   
   
2. Remote Interventions
   Evidence-based, guided interventions for mental health/behavioral health can be delivered on demand, even more so when coupled to remote monitoring. For example, a stress detecting smartwatch combined with app-based delivery of CBT-based interventions was recently assessed in armed forces veterans. It successfully augmented therapist-delivered CBT, improved therapy adherence, and reduced stress, anxiety, and anger.
   
   
3. Remote Assessments
   When real-time data on mental health is indicative of potentially problematic changes to psychological well-being and mental health are detected, device-delivered assessments can be used to see if an intervention is needed — all out-of-clinic!
   
   
4. Advanced AI Support
   “First responder” support bots and individualized emotional support can identify when simple device-delivered interventions should be delivered and/or if a mental health specialist access is required, providing highly streamlined stepped approaches to care.
   
   
5. eCommunication
   Instant and scheduled remote communication can be achieved by text messaging, messenger services, hotlines, or having full psychotherapy sessions through video conferencing. A recent meta-analysis of video conferencing in psychiatry eCounselling sessions revealed it was effective as face-to-face therapy.
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6. eConsults
   Generally, research indicates that 75% or more of eConsults receive a timely response within 3 days, take minutes to complete, and slash the number of unnecessary referrals. Highlights from a recent examination of psychiatrist eConsult platforms in Ontario, Canada include that: 81% of eConsults (30/37) had a 24h response rate, 65% (24/37) were answered with a single exchange;, ~80% of cases were dealt with virtually, and only ~20% were deemed by eConsult to require referral to a psychiatrist or CBT therapist for further assessment.

The Cost Benefits of Augmented Mental Health and Virtual Solutions to Mental Health Care Access
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As the latest advancement in mental health care, cost-effectiveness research on augmented mental health platforms that exploit remote and real-time mental health monitoring is yet to fully emerge. Already improving health outcomes and providing unparalleled remote access to personalized mental health services and care, expectations are high.
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One cost-effectiveness study assessed an augmented mental health platform for improving pain and depression in patients with cancer by combining centralized telecare management coupled with automated pain and depression monitoring. The incremental cost-effectiveness of the intervention using 3 different methods ranged from $10,826 to $73,286.92 per quality-adjusted life year, reclaiming 60.3 more depression-free days per year than the usual care control group.
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In improving primary care physicians access to in-network mental health professionals alone, taking only into consideration collaborative care model benefits, such models of care are considered cost-effective compared to usual care, with an estimated range of $15,000 to $80,000 per quality-adjusted life year gained. Simply using telepsychiatry to deliver 16 sessions of CBT for bulimia nervosa over 20 weeks (without other services) could save a clinic approximately $2025 per patient compared to face-to-face services.

In Sum: Augmented Mental Health is THE Unmatched Escalator Towards Fluid Access to Mental Health Care
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​It is resoundingly clear that eTherapy and eConsults in mHealth platforms could and should facilitate stepped care approaches to ensure access to the right level of mental health care at the right time. There are bountiful implications for improved mental health access, health outcomes, and reduced mental health care costs, where the biggest payoffs are anticipated for augmented mental health systems that capitalize remote real-time mental health monitoring.

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