A few weeks ago, director of the National Institute of Mental Health (NIMH) Thomas Insel announced his departure from public service—and his move to Google Life Sciences. He stated that the mental health world is "seeing an explosion of interest on the device side," and that "many technology companies think mental health is the next frontier."
Those are powerful words, rife with promise and opportunity. But Insel's comments beg the question: If there is so much interest, why aren't there many mental health apps? It's a tricky question, especially since the need for such applications is apparent to those both in the mental health and technology spaces.
"This is a very big, unmeasured gap to fill," says Deborah Estrin, a computer science professor at Cornell University and one of the founders of Open mHealth, a non-profit start-up focused on bringing clinical meaning to mobile health data. When Estrin first thought about Open mHealth, she thought mental health would be a great use for it. "Because we have all this data about the prevalence, cost, impact of mental health conditions, and their co-morbidity with so many other chronic diseases, we see that these are conditions that skilled clinicians can help manage, with really a small amount of self-reported data—data that could be provided by an app," she says.
According to the National Alliance on Mental Illness (NAMI), one in four Americans experiences mental illness in a given year. And the costs of mental illness are in the trillions of dollars. Mental health is considered the largest driver of overall health costs by the World Economic Forum, surpassing the costs of diabetes, respiratory disorders, and cancer combined. The right mobile tool could help patients better manage chronic conditions like depression, bipolar disorder, or schizophrenia, reducing hospitalizations, lowering costs, and improving overall quality of life.
But, Estrin says, creating such applications are difficult. Part of that, she argues, is that there is a missing part of the innovation ecosystem when it comes to developing strong clinical applications. "Really effective applications are not trivial to design—they take time to explore and to validate," she says, adding that the NIMH is focused on basic research, not apps, and big healthcare companies aren't doing it either.
The problem with building mental health apps, says Estrin, is that they are hard to fund, especially with venture capital firms wanting instant, scalable success. "That won't work here because you can't sell this kind of app, whether it's to a patient or a hospital, until there's some evidence that it actually works," she says.
Tanzeem Choudhury, co-founder and CEO of Healthrhythms, which offers a mobile app to manage bipolar disorder (currently undergoing clinical trials), agrees. But she also says that many applications are too focused on the data collection side, instead of thinking about how to better facilitate patient engagement. She says people are spending a lot of time thinking about how to reduce the burden of providing information on the patient side. It can't just be another thing the patient has to do.
"With everything people do on their phones, there are great opportunities to passively pick up information that can help you get a picture of where they are in terms of their mental health," she says. "But app developers also need to ask themselves, what is the patient getting in return for using this app? That's where many people are falling behind." Patients get bored of constantly feeding data into an app.
But even with the right development ecosystem in place and a strong patient-centered design can only take you so far. Venkat Rajan, the medical device industry manager for Frost & Sullivan, says that once you have a good app in place, you then have to deal with the regulatory side of things.
"With FDA regulations and approval, there are a lot of security and other concerns, and those can be obvious liabilities," he says. "So many app developers have intentionally steered away from clinical apps because of that regulatory scrutiny." Those regulations can strongly influence time to market—and a company's development costs.
But, that said, Rajan argues, it's only a matter of time before the mental health apps become more commonplace. "We're still in the infancy of healthcare and medical apps in general. But there's not just a clinical need for mental health apps, there's a lot of monetary opportunity tied to them," he says. "So as the passive sensing and analytics become more advanced, there really is untapped opportunity here. It's just going to take the right innovators to come along and show us the way."
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