While poor mental health is on the rise, a new wave of startups is using tech to help bring treatment to those unable to access it
No matter how you look at it, mental health is one of the most pressing problems society faces. Indeed the statistics are sobering. According to the Health and Social Care Information Centre's Health Survey for England, one in four Brits have been diagnosed with a mental health problem at some point in their lives. The UK in particular seems to be finding itself in a dark place: according to data from the OECD, one in ten people in Britain experience depression, which is twice the frequency seen in countries like Italy, Greece and Poland. And this problem isn't simply going to go away: the World Health Organisation already ranks depression as the leading cause of ill health and predicts that by 2030 it could be the number one global burden of disease. Evidently poor mental health is reaching epidemic proportions.
Suggesting technology could be the cure of all this may raise a few eyebrows. After all, many would swear blind that technology – having brought trolls and Twitterstorms, sexting and cyberbullying into our lives – has done us more harm than good. "In a funny kind of way, the more interconnected we are, the lonelier we are," says Dinesh Bhugra, president of the World Psychiatric Association. "The whole idea of personal relationships is changing: likes on Facebook and Instagram seem to be becoming far more important than actual human contact." And yet despite this, technology paradoxically seems to be bringing mental health out into the open and making it increasingly accessible. Not only do stories about Cara Delevigne's experiences with depression and Emma Stone's encounters with anxiety arrive straight into our Facebook feeds but help for our mental health is also only ever a few swipes away. "On the tube everybody's on their phones and you don't know whether they're playing games or whether they're having their session of cognitive behavioural therapy," says Bhugra.
And without a doubt, we desperately need some new ways of tackling the problem. According to NHS Digital's Survey of Mental Health and Wellbeing, nearly two-thirds of Britons with common mental health conditions don't receive treatment. Part of the reason for this is that treatments that are reliant on therapies or pharmaceuticals are inherently unscalable – the cost per user stays the same regardless of the number of people being treated. "There is a high marginal cost to treating somebody, whether it's pills or face-to-face therapies, so we're not going to be able to do it through the current system,"says Jim Woodsco, co-founder at Zinc VC, whose first mission is to build tech ventures focused on mental health problems. This means that while government spending on mental health has risen to £11.6bn this year, providing treatment for all who needed it would likely need funding raised to well over £30bn. "We all know that's not going to happen," says Woods. "So we're stuck in this situation where mental illness is rising and, under our current system, we're clearly incapable of coping with it."
Fortunately, if there's one area that both startups and technology shine, it's solving problems at scale. While developing an innovative new technology tends to require significant investment up front, the cost of scaling that and rolling it out to increasing numbers of users is trivial – even if they live in regions much harder for traditional medicine to reach. "Virtually everybody in India will have at least one mobile phone even if they don't have access to doctors or psychiatrists," says Bhugra. "So you can download an app that can give you the help you need, whether that is simple information about dealing with stress or a tool for managing an anxiety attack."
Using technological treatments, scrappy startups are in a position to offer those with poor mental health the help they need for much lower costs. Hardly surprising then that entrepreneurs are being drawn to the industry in their droves. "If you're passionate about helping people, working in this field means you're actually impacting their lives," explains David Brudö, co-founder and CEO of Remente, the mental-health and personal-development app. "But, at the same time, there are significant business opportunities because it affects individuals, companies and whole societies."
However, boosting accessibility isn't the only benefit that digital entrepreneurs can offer those experiencing poor mental health: technology can also speed up diagnosis. 'At the moment it takes on average six to eight years for someone with depression to get treatment," says Woods. "A lot of that's because they don't want to be diagnosed as depressed or they don't really realise that they are." While booking an appointment with their GP can feel like too big a step to take to begin with, many of those worrying about their mental health feel more comfortable first exploring the subject online. And the world's largest digital brands are now looking at how they can support this: Google recently began trialling an online depression test in the US that appears alongside searches on the subject, while Apple is currently recruiting software engineers to help Siri better respond to users asking questions about mental health. "Through things like Google or Siri, you can start to diagnose these things much earlier," Woods says. "You wait for people to go out to their therapist or GP, you may be waiting years and years but actually digital could massively shortcut that process."
Beyond just offering general advice about mental health, thanks to the amount of data now available from things like apps, fitness trackers and social media, tech can also offer far more personalised insight. "Because we're posting so much online, by doing big-data quantitative analysis, you can draw really interesting conclusions and understand someone before they understand themselves," Brudö says. For example, by taking into account data on things like how much exercise users have had, how well they've slept or the amount they've interacted with friends, startups can potentially provide users with actionable insights on the things that have historically helped to boost their mood. Additionally, this kind of information could also act as an early warning system, helping users recognise times at which they may feel more vulnerable. "That's where technology becomes really interesting, both when looking at warning patterns but also preventative measures to suggest things for people to keep them on the right track," says Brudö.
But perhaps one of the most powerful things technology can do is to continue doing what it always has done: making it easier for people to communicate with each other. "There's some research that King's College London did that found the best way to break down stigma is to have access to other people who are going through mental health problems," says Jayne Hardy, founder and CEO of the Blurt Foundation, the social enterprise dedicated to increasing awareness and understanding of depression. "For those who are feeling isolated, it's a way to make connections and to feel less alone, which will probably save lives." By making it easier for people to share their experiences and plugging isolated people into communities of individuals who understand what they are going through, technology can weaken some of the taboos that persist around the subject and help normalise mental health as something everyone will experience. "It's that knowing nod that really understands what you're going through when you're feeling so odd, so weird and so detached from how life was for you before," says Hardy.
While there are certainly many promising avenues for startups in the sector to explore, this is not to say that there aren't some challenges to face. And the first is likely to be familiar for any entrepreneur with experience of entering a new vertical. "It's a very embryonic market," says Woods. "Very few early stage businesses are yet to make it across the valley of death." For every Big White Wall and Sleepio that secures series A or B investment, there are many more startups struggling to draw down signficant funding. And part of the reason for this is that currently nobody is 100% clear on who the customer is. While nobody is denying that improved mental health solutions will benefit individuals and society as a whole, the government and the NHS are much quieter when the subject is raised of who's going to pay the bill. "Investors looking at digital mental health are just going: 'Who is going to pay for all this?'" Woods says. "There's no revenue model."
And this directly contributes to perhaps one of the biggest issues the industry currently faces. "There's still not a huge evidence base that individual solutions are as good as face-to-face therapies or pills," says Woods. "In fact if you go to the App Store and put depression in, you'll find 400 or 500 apps in there: some of them will help, some of them will do nothing and some of them could actually be harmful." One of the big criticisms that is levelled against digital players entering the mental health space is that they aren't subjected to the same scrutiny as other clinical interventions. But as well as being prohibitively expensive for startups without a guaranteed revenue stream, lengthy double-blind trials aren't much use if in six months you have entirely redeveloped your product. "Pills stay the same: digital platforms are constantly evolving," Woods says.
Fortunately, if there's anything startups excel at, it's testing and tweaking things in a live environment. While more traditional trials are restricted by the number of people they can physically assemble and work with, digital platforms interact with thousands of data points, meaning they can potentially assess far faster what does and doesn't work for their users. "We have hundreds of thousands of users and we can draw conclusions of what works based on their useage," says Brudö. "To have a clinical study with that mass of people would take years." And this could provide a valuable testing bed for all kinds of interventions, providing data that speeds up the existing trials process for other medical interventions. "With the right kind of frameworks around it, technological products could actually be a superb tool if they worked together with the science community and the universities," Brudö says.
If it's able to overcome some of these hurdles, however, the startup community certainly stands to make a real difference when it comes to mental health. And while some people may still be sceptical that technology can be both cause and cure, as with most tools the critical thing is how we use it. "Like with everything there's a negative side to it, which can be ugly, scary and dangerous at times,"says Hardy. "But it also shines light on great things: people are coming together working as a community to address something that they're passionate about." And while she doesn't believe that technology can ever completely replace having a real-life support network, that doesn't mean we should ignore the benefits it can bring. "I don't think it could or should ever replace spending time with loved ones and friends: a virtual hug is not going to be the same as a real hug," she concludes. "But technology still enables us to do amazing things."