How technology can improve access to mental health care

From telehealth and TikTok to artificial intelligence and virtual reality, the mental health care industry is embracing technology — but it’s making many clinicians uneasy. From concerns about the ethics of mental health influencers to the inaccuracy of mental health advice on TikTok and to complaints about teens misdiagnosing themselves, many experts are uncomfortable about the role technology is playing in mental health support.

But technology can also help solve what’s arguably the industry’s biggest issue: access. Given the ongoing mental health crisis and the fact that many people lack adequate access to quality mental health care, it’s essential to strike a balance between technological innovation, the pace of clinical validation, and high ethical and safety standards to ensure that rigorous, culturally centered mental health support is widely available at a time when it’s so desperately needed.

Technologically dubious past

Mental health clinicians and researchers have not historically prioritized technology and marketing. Training for mental health clinicians and scientists typically focuses on delivering therapy or conducting research, without a heavy focus on technology or industry. In my own experience as a clinical psychologist, I’ve seen colleagues minimize things like marketing and treat working in the mental health tech industry as less rigorous than working in academia or traditional health care settings.

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In terms of marketing, evidence-based mental health care has been clobbered by Big Pharma. Years of countless ads, promotions, and aggressive sales tactics have made mental health treatment synonymous with psychiatric medication instead of behavioral intervention. So when people think about depression or anxiety today, many think only about taking Prozac or Xanax without understanding that interventions like cognitive behavioral therapy can deliver equivalent — or possibly even better — results.

The Covid-19 pandemic changed everything. Barriers to telehealth care disappeared overnight. At the same time, the trauma of the pandemic increased conversations about mental health. Many people stuck at home leaned on social media to socialize and seek support for their mental health. This shift opened the floodgates for the nascent mental health tech field. But without the involvement of clinicians and researchers, there’s a risk that the solutions won’t incorporate the scientific, ethical, and safe foundations needed to ensure they’re providing optimal support.

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Access issues

More people seeking mental health care is a good thing — unless there aren’t sufficient options for them to be able to address it. Access is also an equity problem, since people of marginalized identities are disproportionately unable to get the care they need.

The American Psychological Association estimates there are just 34 licensed psychologists for every 100,000 people in the U.S. In a survey last fall, APA members reported a huge surge in demand, but 65% said they had no capacity for new patients and 68% said their wait lists were longer than they were in 2020. While there are a number of other professionals who offer therapy (psychiatrists, licensed marriage and family therapists, clinical social workers, coaches, and the like) there simply aren’t enough providers to meet the growing need.

The flood of people seeking care is overwhelming the current crop of mental health providers. Many don’t have an incentive to accept insurance when the average insurance company pays providers low rates — on top of the required and time-intensive administrative and billing work, for which they aren’t paid at all. The result: Those who do accept insurance have extremely long wait lists.

Psychotherapy not covered by insurance costs the average American between $100 to $200 per session, making the cost prohibitive for most people who don’t have insurance. That compounds the supply-and-demand problem and further excludes individuals who don’t have insurance or the financial means to access care.

Opportunity for tech

Improving access to mental health support is a perfect opportunity for technological innovation. Whether it’s through an app, blog, or social media platform, technology provides an alternate avenue for more people to access high-quality and evidence-based mental health support, incorporate novel well-being strategies into their lives, and reduce stigma through more open conversations about mental health that normalize concerns and choosing to seek help.

When it comes to mental health support, the stakes are extremely high because people’s lives are at stake; the same gravity for physical health concerns applies here. Mental health affects all aspects of people’s lives — their daily functioning, quality of life, overall health, relationships, and more — and it can be the difference between life and death, since mental health issues are associated with increased mortality and suicidality.

Innovation for innovation’s sake can’t be the goal. Instead, it should be aimed at addressing the known challenges that are limiting access to the mental health care system. Knowing the complexity and nuance of mental health concerns and care, clinicians and researchers are hesitant to rely on technological solutions because of concern about the potential for harm, but this isn’t an either-or situation.

While one-on-one therapy with a person is the ideal intervention for certain types of mental health concerns, this is often a reactive strategy and isn’t the only evidence-based method for effectively addressing mental health issues, given the full spectrum of needs and the impact of personal preferences. Technological advances offer an opportunity to reimagine how proactive care can be.

For instance, researchers have been looking into the possibilities of leveraging artificial intelligence to monitor data from smartphones and wearable biosensors to determine whether an individual is contemplating suicide. That’s an extremely serious task, and one many clinicians feel uncomfortable leaving up to an algorithm. At the same time, this extremely serious task can’t be put on the shoulders of clinicians if there aren’t enough of them to meet this mental health need in the first place and monitoring patterns in such complex data isn’t possible for humans. It’s also important to consider the vast number of people who have zero or minimal access to quality mental health care, including those experiencing suicidal thoughts.

So the comparison for “best possible care option” shouldn’t be between AI and one-on-one therapy — it should be between AI and no care at all. Then the questions become: How can clinicians use technological advances to address gaps in their own capabilities, address escalating needs, and deliver better care? And how can they inform these advances to minimize the risk of harm for patients?

That said, at an organizational level, for example at health tech companies, it’s essential to have clinicians and researchers who are competent, ethical, and rigorous involved in the development of digital health technologies, who understand the implications of the work, and who can determine how effective or harmful innovations can be. The same is true for those incorporating technology on a smaller scale, like into their own private practice. For example, I don’t think TikTok is a platform for delivering therapy, but it can be used as a resource for education and removing the stigma from mental health issues, considering its wide reach and ability to normalize taboo topics. Clinicians and researchers will also have to rely on their ethical guidelines and training to evaluate the clinical validity and appropriateness of the content they share on TikTok and acknowledge the complexity of many mental health topics.

In an ideal world, everyone having mental health issues would be receiving some form of evidence-based treatment. In the real world, many are not — and can’t get it based on the limitations of the mental health care system. Interventions based on technology could be the best chance of actually getting care to all of the people who need it, even if it doesn’t look like traditional psychotherapy.

Reconciling the pace of progress

There will always be an inevitable tension when bringing together academic science and technology because the two move at different speeds. Science is known for its slow and methodical pace. The average grant cycle for academic research is at least four years, it takes at least another year to get something peer-reviewed and published, and then even longer for those findings to make their way into mainstream care, if they ever do. In contrast, technology is known for moving fast and breaking things.

Given the silos that mental health clinicians and researchers have been working in, some of the innovation needed today is not scientific but simply a matter of externalizing the last several decades of work. Years of academic research and studies around best clinical practices have uncovered solutions that aren’t being used as broadly as they could be. The partnership between innovative and traditional clinical care should include taking what already exists and putting it into play in new and effective ways.

To advance innovation in mental health care, it’s important that clinicians not get territorial. Psychotherapy with a licensed clinician is one data-backed strategy for mental health concerns, but it isn’t the only data-backed strategy. There will always be a place for human interaction in mental health care, meaning clinicians will always have a role in addressing mental health concerns. But overburdened providers need new strategies and resources to help all of the people who need it. It’s time to consider innovating who or what can provide support and care, how that care can be delivered, and what sorts of strategies people can do on their own to take care of their mental health. Evidence exists for the effectiveness of all of those approaches, and digital health tech developers should be partnering with researchers to provide high-quality evidence for real-world implementation.

When it comes to mental health care, clinicians and researchers have historically prioritized traditional health care roles and deprioritized incorporating technological solutions. That has left a void that’s being filled by non-experts. Clinicians and researchers need to get involved with informing every aspect of digital mental health care, from product and tech development to sales and marketing, to ensure that everything is grounded in safe and ethical care and to ensure that leadership teams understand the necessity of involving clinical experts. Those who feel comfortable being on TikTok and Instagram should do so to add their well-informed voices to the discourse. The ideal balance is a combination of clinical rigor and innovation, pairing learnings from the past with technology of the future that has the potential to reach millions quickly.

The growing mental health crisis is way too important and widespread to rely on one solution.

Jessica Watrous is a licensed clinical psychologist and director of clinical and scientific affairs at Modern Health, a workplace mental health platform.

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