The following is a guest article by Ken Cahill, Chief Executive Officer, SilverCloud Health.
The COVID-19 pandemic has imperiled our communities on a scale that we rarely witness, and the pressure we’ve felt from a public health and economic standpoint cannot be understated. As a leader of a digital mental health company, I’ve experienced the pandemic through the lens of our emotional wellbeing, and it’s been difficult to watch unravel.
In the United States, our mental health system already had its deficiencies – the most obvious of which is that we have a shortage of mental health professionals. Per 100,000 people, we are equipped with 30 psychologists and 15.6 psychiatrists, and over 115 million people reside in designated Health Professional Shortage Areas – areas in which the ratio of mental health professionals to residents is smaller than 1 per 30,000 people. When those circumstances are paired with the fact that 53% of adults in the U.S have reported that their mental health has been negatively impacted due to worry and stress over the coronavirus, we are left with a mental health pandemic in and of itself.
It’s no surprise then, that digital mental health has been thrust into the limelight as evidenced by the industry’s growth so far in 2020. It’s more easily accessible, it’s affordable, and it can be scaled. However, what’s been nebulous amid this public health crisis is the difference between meditation and mindfulness applications and digital therapeutics under the digital health umbrella – where the variable is the clinical efficacy of the service. This conflation emanates from marketing tactics; for example, some services claim they deliver clinically validated and measurable outcomes by citing their articles in predatory journals where the merit of publishing depends on payment versus a formal peer-review process. In a time where mental health demand is at its pinnacle, it’s important for organizations to understand how to vet the efficacy of each.
One of the core reasons how some meditation and mindfulness applications can market the efficacy claims they make is due to the absence of an adequate regulatory framework in the United States by the Food and Drug Administration (FDA). Countries, such as England, have established The National Institute for Health and Care Excellence (NICE) that evaluates effectiveness of digital mental health tools (DMHT). This lack of regulation allows the marketplace to uncontrollably thrive; to date, there is an estimated 350,000 health apps with 10,000 focused on mental health. Out of those 10,000 mental health applications, a clinically relevant app for depression is deleted from the app store every 2.9 days. Consequently, it’s difficult for users, peer support specialists and clinical providers to stay informed on the safety and efficacy of these services.
At a minimum, at least one well-powered randomized controlled trial (RCT), conducted in a relevant setting, using an accepted condition-specific outcome with participants who are representative of the target population, should be required when a DMHT represents a novel intervention or new technological medium.
In tandem with clinical efficacy, it’s important that organizations also understand the DMHT’s proven engagement with patients. This has been a challenge for some DMHTs; for example, while some trials have demonstrated strong patient engagement in acute settings, others have had high dropout rates. A best practice standard would demonstrate high levels of sustained patient engagement with the tools in a well-designed RCT. Along these same lines, healthcare workers who coach guided DMHTs can face challenges in maintaining engagement due to fitting tasks into the workflow, lack of adequate training and support, and hesitancy to taking on new tasks with unclear productivity metrics.
Lastly, to assess the performance of the DMHT, especially if it claims to improve symptomology, the digital tool should deploy clinical outcome metrics. In the case of anxiety and depression symptoms, a reliable measuring method is to conduct the Patient Health Questionnaire (PHQ-9) for depression and the Generalized Anxiety Disorder (GAD-7) for anxiety. Such patient reported measures are utilized in traditional cognitive behavioral therapy and have been adopted into internet-based cognitive behavioral therapy programs. Any digital mental health service that is devoid of clinical outcome measures cannot accurately claim that they improve symptomology.
Whether a health system, insurer, employer or university, organizations committed to offering digital mental health services need to evaluate their prospects through a scientifically grounded approach, where clinical efficacy is manifested through an evidence standards framework involving scientific studies and validations. Digital mental health services that offer this level of evidence are best positioned to provide effective, measurable mental health support to patients who are struggling with emotional difficulties. Meditation and mindfulness applications are valuable to the extent that their clinical evidence claims, and they should be marketed as such. What’s important is that organizations understand how to properly vet this congested landscape, and that they do so with a firm discernment of the evidence framework behind each service.
About SilverCloud Health
SilverCloud Health is the world’s leading digital mental health company, enabling providers, health plans and employers to deliver clinically validated digital health/therapeutic care that improves outcomes, increases access and scale while reducing costs. The company’s multi-award-winning digital mental health platform is a result of over 17 years of clinical research with leading academic institutions. Today, SilverCloud is being used by over 300 organizations globally to meet their populations’ mental health needs. Global experts have deeply validated the platform through full randomized control trials and real-world data from nearly 500,000 SilverCloud users. The platform continues to lead the industry with its effectiveness, engagement and range of clinical programs that encompasses the spectrum of mental health needs. Learn more at www.silvercloudhealth.com.
