Technology-Enabled Care: The Future of Our Field

I am delighted to introduce this important supplement of Psychiatric Times™. In the context of the COVID-19 pandemic, telepsychiatry has passed its tipping point and now become a mainstream method of providing mental health services. In contrast, more complex solutions such as artificial intelligence, technology-enabled care, and smartphone applications are not yet mainstream.

However, the integration of digital technologies into psychiatric care has only just begun. Looking ahead, I believe that technology-enabled care will be the defining advancement of mental health services in this generation. I believe there are 3 key trends that have shaped how we got here and give us clues to what the future holds.

Rapid Erosion of Stigma and Surging Demand

The COVID-19 pandemic created a series of conditions that both increased the overall risk for mental illness and triggered specific episodes: uncertainty about life or death, bereavement of loved ones, chronic isolation, job loss, financial uncertainty, and loss of numerous life events (prom, graduation, weddings, etc). The result has been a rapid increase in anxiety, depression, and alcohol use, with a whopping 40% of Americans reporting at least 1 mental health condition, and more than 10% seriously considering suicide.¹

At the same time, the pandemic circumstances have made it easier to talk about these experiences of depression and anxiety, in part, because they were understandable reactions to the various facets of a global crisis. On top of that, celebrities and other influencers have been speaking about their own mental health challenges, thereby normalizing the experience and providing hope for treatment.

For examples, 23-time Olympic gold medalist swimmer Michael Phelps, and singer-songwriter Demi Lovato have both shared their experiences as part of serving as marketing ambassadors for Talkspace. Similarly, tennis player Naomi Osaka, the highest-paid female athlete in the world, recently shared her experience with depression and anxiety in an Instagram post, explaining why she did not want to participate in postmatch conferences.

These are not isolated events, and they make a huge impression on individuals everywhere who have their own struggles with mental health. As a result, an increasing number of people are seeking treatment than ever before.

Great Influx of Private Investment in Mental Health

Observing the decline in stigma and rise in demand, investors have been pouring money into mental health. For instance, earlier this year I published a discussion on this topic after finding that venture capital investors dedicated a record breaking $637 million to mental health startups in 2019, which was a 23-fold increase from 2013.² Estimates now suggest that venture capital investment topped $1 billion in 2020 and is poised to surpass $2 billion in 2021.³

In addition to venture capital, private equity companies are also investing in mental health; they are focusing on consolidating addiction facilities, residential treatment centers, and outpatient mental health clinics. In June 2021, LifeStance Health, one of the nation’s largest providers of outpatient psychiatric services, joined the Nasdaq stock exchange in an initial public offering just 4 years after being launched.⁴ This trend will likely continue.

You may be wondering why private investment is relevant to technology. We know technologies provide opportunities for mental health treatments to be scaled up. For investors, technology is attractive, as it is the key to driving larger returns. As we see more and more investment in mental health from private investors, I expect to see a greater focus on digital technologies, ranging from the basics like appointment scheduling and messaging between patients and clinicians, to more advanced features like chatbots and do-it-yourself smartphone applications as initial or complementary treatments. For psychiatrists, these technologies will enable us to treat more patients and disseminate care more widely than ever before.

Toward a Post–COVID-19 Future: Hybrid Care

The big question is: How will we get from where we are now, which is a loose combination of telepsychiatry and traditional care, to this futuristic digitally enabled care model?

Like all sustainable innovation, I predict that technologies will advance incrementally, steadily marching toward the day when digitally enabled care will be the norm (Figure). Just as telepsychiatry is now a patient expectation, patients will also expect appointment rescheduling, billing, and documents (including signature) to be fully digital in the next 10 years. In addition, the ability to send asynchronous messages to the provider in a secure format will be common. Finally, as insurance companies play a role in how care is reimbursed and delivered, there will be a growing expectation that digital tools (ie, smartphone application modules for cognitive behavioral therapy) will help to reduce either the length or number of sessions needed for milder conditions and treatments.

Concluding Thoughts

The world is digitally powered, and our treatments will have to be digitally enabled if we are going to meet patients where they are: on their smartphones. Demand is surging, stigma is declining, and private investors will continue to push technologies that scale up our treatments. The field of psychiatry is poised to take advantage of this brave new world to better care for patients. I have never been as excited to be a psychiatrist as I am today. Happy reading—our future awaits!

Dr Shah is the Chief Innovation Officer at Columbia Psychiatry and assistant professor of psychiatry at Columbia University Irving Medical Center. He is an advisor and holds equity in the following mental health startups: Two Chairs, Mantra Health, Tempest, and GroupWell. These companies are not referenced in this article.

References

1. Czeisler MÉ, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic - United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-1057.

2. Shah RN, Berry OO. The rise of venture capital investing in mental health. JAMA Psychiatry. 2021;78(4):351-352.

3. Thorne J. Driven by pandemic demand, mental health startups surpass 2019 funding. PitchBook. October 14, 2020. Accessed June 29, 2021.

4. Landi H. Mental health provider LifeStance Health valued at more than $7B as stock jumps following IPO. Fierce Healthcare. June 15, 2021. Accessed June 29, 2021.