In this episode I chat with Dr. Stephen Schueller about the role of technology in treating people for mental health conditions as well as the landscape of existing technology solutions, and those that are yet to be built.
Dr. Schueller is an assistant professor of Psychological Science at the University of California in Irvine and he is also the Executive Director of PsyberGuide, which is a non-profit functioning as the ‘consumer reports’ agency of the mental health technology world. Dr. Schueller has a team of people who evaluate technological tools (such as apps, and other tools) used in the treatment and improvement of mental health.
SOME OF THE THINGS WE TALKED ABOUT:
- What is the role of technology in mental health? Can we use technology to treat and or diagnose people suffering from mental health conditions, addiction, etc.? Dr. Schueller shares his thoughts about how technology is unavoidable in our daily lives to some degree and how we can leverage that for the improvement of mental health within society. This will include the use of some apps, websites, devices, etc. that were intentionally built for mental health purposes as well as some that were not. Ultimately, access to treatment is one of the biggest hurdles to getting people help who need it, and technology can help remove some of that access barrier.
- Is technology useful in clinical treatment of mental health conditions? Dr. Schueller talks about how traditional services (face to face therapy, etc.) are great, and they work for many people, and some people want traditional face to face services. However, not everyone feels this way. Technology expands the available options so that different people can get exactly what they want or need in the mental health resource space. In the event that someone is not receiving care for one reason or another, and where a technological solution can bridge that gap, then technology is certainly useful not only then, but in many other applications as well.
- Can we use technology to test, measure and diagnose mental health conditions? Dr. Schueller explains how he thinks about the clinical utility of technology in this space. He uses 2 questions to being to test the effectiveness of an app, or technology.
a) First question – Is the input useful?
b) Second question – is data or the translation of that data a clinically meaningful insight that can help a client or patient improve their life?
We must think about where we get data, and how we interpret it. There have been many great developments and inventions in the data gathering area, but we still have a long way to go when it comes to interpreting the data that we gather from all these wearable devices.
- Should we be relying on surveys or measurements for analysis of our mental health status? Dr. Schueller talks about how mental health assessment is fundamentally broken. Surveys like the PHQ-9 are not as effective as passively collected data when it comes to things like sleep patterns and quality, however when it comes to thoughts of self-harm survey data is likely better than some passive measurement. Dr. Schueller explains that, “we need to think about how to optimally bring together data streams to give a full picture, or triangulation of what a person is going through.”
- Should startups in the mental health tech space be focused more on technological innovation or clinical accuracy? A tug of war, of sorts, exists between clinicians and technology focused entrepreneurs. We have to make sure that in the process of helping people, that we do not harm people. There is a fine balance to walk between “moving fast and breaking things” and helping people with their mental wellness. Some of the challenge around innovation in this space is that often technologists don’t have an understanding of what standards of clinical care looks like. We must innovate from a place of understanding standards of care and standards of practice. There are lots of places we can innovate while being responsive to minimizing harm, while maximizing benefit for patients and individuals suffering from mental health problems.
- What is PsyberGuide? It is the consumer report of digital mental health products. This is a non-profit that Dr. Schueller helps to run with the support of numerous partner agencies such as:
a) Anxiety and Depression Association of America
b) International Obsessive-Compulsive Foundation
c) American Institute for Stress
d) Mental Health America
Dr. Schueller explains how there are thousands of digital mental health products out there. There could be somewhere between 10,000 and 20,000 apps or tools out there from his estimate. Very few have any evidence-based support behind them – he estimates that about 3% of those apps have any kind of evidenced based support behind their approach.
PsyberGuide focuses on separating the good from the bad in this space.
Their reviews provide structured, consistent frameworks for looking at critical aspects of a product. Their reviews focus on these key areas:
a) Credibility of the product or platform (or the science behind it)
b) User Experience (engagement, likeability, etc.)
c) Transparency (Data security / Privacy ) – They review the policies of the company or app, but they do not do a full technical audit of the privacy practices
- We talked about data security in the space among the apps in the industry. Recently Dr. Schueller’s team looked at 120 apps focused on depression. He indicated that half of those apps didn’t have any data security policy at all. Of the ones that did, only half of those (25% total) had policies that are acceptable by industry standards. Dr. Schueller goes on to explain that there isn’t a lot of transparency on what many products are doing with your data. This must be addressed and resolved in this industry.
- How many apps or startups are out there in the mental health space? As mentioned previously, there are somewhere between 10,000 and 20,000 mental health apps on the market (depending on how broadly you define the search criteria). The barrier to entry to build in this space is very low.
Many of the apps are one-off apps that are not maintained or supported or have “failed” or been abandoned in an app store somewhere. A large portion of them are just put up by people with some programming experience but no science or clinical team behind it. This is why PsyberGuide exists.
Some of the apps are built by entities that have dozens of apps out there. One group that Dr. Schueller references has about 20 apps of their own. So, when you consider this, the number of abandoned apps, and the low percentage of apps that have any clinical evidence behind them, there seem to be about 3% to 5% of the 10,000 to 20,000 that are viable. This would imply a market size of maybe 500-1,000 startups or companies and that is consistent with my (Stephen Hays) prior analysis on this industry.
- How do you pick which apps PsyberGuide reviews? There is a little bit of art and a little bit of science to this. Dr. Schueller explains that they track the app store, as well as the research world and keep track of what’s being researched, and what’s being built. They also have partners (mentioned above) that often come and ask for help reviewing a technology. Additionally, they track traffic on their own website to see what consumers are interested in learning about and use that to manage workflow and prioritization as well.
- Why do we need something like PsyberGuide? Dr. Schueller talks about how there isn’t anyone out there policing or patrolling this space. The mental health care industry could be one of the largest industries in the world with billions of people in need. The FDA can’t possibly review everything. PsyberGuide hopes to become the gold standard of independent reviews for digital mental health solutions
- Why are technological solutions to mental health are needed? I asked Dr. Schueller about why we need teletherapy and some of these other solutions. He explained to me that 1 in 3 counties in the US do not have a licensed psychologist and that 70% of counties in the US do not have a child psychologist. The access problem around mental health is huge. Technology will be required to fill the gap. He goes on to describe that in a perfect world, technology is used to supplement therapy and to make it faster, better and more efficient. Technology can help us transcend time and space to reduce the access issues we are facing today.
Dr. Schueller also talks about how technology can take insights from daily life and help make the information gathered from our daily lives actionable when it comes to our mental wellbeing.