Thorny Problems in Mental Health and Well-Being

I’ve said it before, and I’ll happily say it again: nothing inspires me more than a day spent with passionate, invested people. This time, I was inspired by ILN West Coast. The ILN sponsored this one-day meeting with healthcare organizations. The topic: thorny problems in mental health.

There are plenty of challenges in mental health. Bringing together startups and hospitals, payers and psychiatrists, allowed us to discuss some of these issues from multiple perspectives. It opened my eyes to new ideas as well as new technologies.

Thorny Problems in Mental Health

The ILN West Coast meeting followed a specific format. Presenters shared case studies, each ending with a challenge – a “thorny problem.” Presenters included Kaiser Permanente, HopeLab, Sutter Health, Children’s Hospital LA, and many more. Each organization presented fascinating new technology, services, programs, or ideas. And each had a difficult challenge, which faces all of us working in healthcare. As Chris McCarthy, our host and MC reminded us, these thorny problems are what we are here to discuss and – eventually – solve.

I’m still thinking about those challenges several days later. Here are a few of the thorny problems in mental health.

How Do We Get Digital Interventions To People?

“If you build it, they will come.” It may have worked for Kevin Costner, but it’s just not true for healthcare. We came up with a few ideas around this challenge:

  • Onboarding: It’s natural to initially design for power users. But we rarely consider how someone first finds the app or site. Is it prescribed? Is the patient doing this with someone else, or on their own? How do they learn how the intervention works – should that be designed into the experience?
  • Outreach/marketing: If patients are expected to find the intervention on their own, we need to engage marketers. An ideal outreach plan will consider why patients need the intervention, and when it will be on their minds – as well as where they will have connections to it in the digital or physical world.
  • Partnership: Successful a digital intervention require more than internal collaboration. We have a fractured health ecosystem, and successful interventions help to bridge programs, platforms, and organizations.

What Ethical Considerations Should be Required?

To their credit, many digital health organizations take great care to involve researchers, and create evidence-based platforms. But evidence-based is not the same as ethical. Our ideas here had a common theme: we need to define intentions, and proceed deliberately. For example:

  • Autonomy: Designers and healthcare practitioners do make decisions on behalf of patients. We often pretend we don’t, but even by determining “your life will be better if you don’t struggle with depression” we are making a choice (one that some cultures might disagree with). In order to better discuss ethics, we may need to first acknowledge that we are making decisions that impact patients.
  • Inclusivity: In an effort to help more people, it’s common to make statements like “our product is for everyone.” But that’s rarely (if ever) true. If you were to create something for everyone, you must account for the unique cultural, demographic, and behavioral aspects of everyone who might use it. It’s much more likely that your product is for a subset of people. By identifying that group, you’ll be able to learn more about their specific needs, and be more intentionally inclusive.
  • Measuring success: It may not seem it, but how you measure success is an ethical decision. For example if you measure success by the length of time a patient continues to use your app, but patients whose situation improves are likely to stop using the app, then you will be faced with an ethical dilemma. Therefore, measurement choices are ethical considerations.

How do you make a Digital Therapeutic a Prioritized or Prescribed Tool?

When it comes to digital therapeutics, the competition is surprisingly steep. There are a plethora of apps available, few of which are tested and valid. As such, this question covered a wide range of opportunities.

  • Human-centered design: The most popular therapeutics will ultimately be those that focus on the patient’s experience. To that end, no platform will likely become the prioritized tool without a human-centered design approach.
  • Consumer-driven vs Provider-driven: Tools provided by a doctor come with a certain level of trust (at least among those who trust their doctors). However, that method of delivery may also feel clinical and formal. Depending on the tone, goals, and approach of the digital therapeutic, the best approach may vary
  • Engagement: Whether prescribed by a physician, or recommended by a friend, no digital therapeutic will successfully help a patient until it is used. Thus engagement – ideally based around a behavior change strategy – is a key consideration.

Addressing the Thorny Problems

I’ve barely managed to scratch the surface of the wide array of topics we discussed. For every thorny topic in mental health there are dozens, maybe hundreds, of brilliant minds at work. Many thanks to ILN for bringing a few of them together! I feel lucky to have been around them, and hopeful for the future.

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