How Digital Health Solutions Can Address Shortages in Mental Healthcare

October 05, 2022 - In any given year, approximately 21 million people in the United States will experience one depressive episode. According to the National Institute of Mental Health, depression rates are most prevalent in adults between 18 and 25. Despite the rate of mental health issues, there is a current shortage and lack of access to mental health resources. Meru Health, an online mental health provider, and Curebase, a provider of decentralized clinical research, worked together to develop an app that may provide a digital solution to address the current challenges in mental healthcare.

PharmaNewsIntelligence sat down with Nick Peiper, PhD, MPH, psychiatric epidemiologist, director of Research at Meru Health, and principal investigator of this study to discuss the product further.

Throughout the discussion with PharmaNewsIntelligence , Peiper described the app. He explained, “it is a 12-week smartphone application to address depression, anxiety, and burnout. Evidence-based modalities are delivered weekly, from mindfulness to behavioral activation and stress reduction. The app also has modules on sleep hygiene and nutrition.”

The App

He explains that the app is multifaceted and covers multiple topics typically covered during in-person or virtual cognitive therapy. “There are a whole variety of topics that our app covers every week,” he emphasized.

Beyond the cognitive aspect, the researchers have also implemented ways to track and address physical responses to depression, anxiety, and burnout. “The other researchers and I also have a biofeedback device that we send to each one of our patients. This device is focused on heart rate variability biofeedback. Through the app, we can teach people how to engage in breathing exercises and provide psychoeducational modules on how to do that and how to use the device. We're able to measure that information and see if those improvements in heart rate variability are associated with better clinical outcomes,” revealed Peiper.

Modalities

Over the span of 12 weeks, each patient will receive the same set of educational modules. The modules take on multiple forms. “Each week, an introductory video introduces the weekly topics for its users. So, by watching that introductory video, they unlock different exercises they can engage in and use the materials,” he explained.

While the app and accompanying modules function as the primary form of treatment, Peiper notes, “the program is therapist supported. There's a chat feature where patients can chat with a licensed therapist at their leisure. If there are any other issues they may be experiencing with the app, they can reach out.”

Patient Support

Because the app is meant to enhance mental healthcare, researchers provide options for additional support when necessary to ensure patient well-being. “Depending on the issue, there can be a phone call or follow-up. Those are typically rare, but instances of symptom deterioration or things of that nature can call for it,” he added. “Every patient is also part of a small cohort of patients that go through the program simultaneously. So, there's also a group chat functionality where patients can anonymously share how their week went and have a virtual support community available to them.”

Study Design

While the study has yet to yield results, Peiper gave PharmaNewsIntelligence an overview of the study design. “The study is a hybrid type one effectiveness trial of our product in primary care. Essentially, the other researchers and I are primarily interested in the clinical effectiveness of our 12-week program compared to treatment as usual. That could range from psychotherapy, pharmacotherapy, other mental health supports, or a combination thereof,” he began.

Peiper and his team also set out to understand this tool can be applied practically. “The secondary objective is to evaluate how this is implemented in a real-world setting. Some things will go well, but then there are also probably going to be barriers that occur. In addition to interviewing patients, my team will also interview providers and the administrators of the primary care sites to see how this process went and what things were efficient. Conversely, were there things that were inefficient for the providers, and how can we best implement these things?” shared Peiper.

Study Phases

Peiper and his colleagues have divided the research into two phases to get a well-rounded view of the app’s effectiveness and application. “The high level is that we have a smaller study to be implemented at one primary care site. And then, next year, we will be doing randomized control trials across eight primary care sites. The ultimate goal is to determine the effectiveness of our 12-week digital solution to treat depression in primary care,” he asserted.

“The first phase is a proof-of-concept study. That is just a small study with 30 participants: 15 of whom will receive Meru Health and 15 who will get treatment as usual. This starts with one primary care site. The team wants to see how this goes before we ramp up for the second study phase,” Peiper expanded.

Assuming success in the proof-of-concept study, the next step will be to research a larger cohort. Peiper revealed that the study’s second phase will be approximately 10 times larger and occur in 8–10 primary care sites. This phase will recruit about 150 patients for each treatment method.

Peiper explains that he and his team will “be able to understand what materials people are engaging with, how often they might be doing their breathing exercises, and how often they might be chatting with a therapist or chatting with other people in their patient cohort. This will provide very detailed and granular data on engagement that the team will be keen on understanding.”

Beyond tracking symptoms and progress during the 12 weeks, Peiper and other team members intend to monitor patients for one year after treatment. This provides a better understanding of long-term recovery pathways and sustained progress. During these 12 months, patients will be able to return to any of the previously used modules.

Accessibility

Lack of access to mental health resources remains a significant barrier to access to treatment. However, Peiper and his peers believe this app will become an essential tool for overcoming that barrier.

According to the Association of American Medical Colleges, the shortage of mental health professionals will range from 14,280 to 31,109 psychiatrists in the coming years.

When PharmaNewsIntelligence asked Peiper how this application differs from traditional mental health resources, he said, “The accessibility and the ability to rapidly get care. In the US, we're unfortunately experiencing a mental health crisis. Part of that problem is that there is such a limited mental and behavioral health workforce. People must wait to get into face-to-face care or find other forms of care. Meru Health’s solution is something people can immediately get access to and address some of those ongoing issues.”

In addition to decreased wait times and readily accessible care, the app can be done from the comfort of the patient’s home or wherever they are most comfortable.

Cost

A recent brief released by the Biden administration stated that in 2020 nearly $280 billion was spent on mental healthcare. Considering the high cost of mental health services and lack of coverage, Peiper emphasizes that the benefit of this product is that it reduces the need for transportation, thus cutting down on spending.

Due to the early stages of research, it is unclear what the cost of this tool will be. That said, Peiper anticipates that this will be priced per session, like other mental health resources. Despite an underdeveloped idea of cost, the reduced need for direct contact with a licensed healthcare professional may also contribute to a more cost-effective approach.

“Ultimately, the goal is to provide this sort of solution in primary care. It's a common place where people experiencing mental health problems go. It's one of the first places they go, and they engage with their primary care physician. Suppose there are ways to measure depression and anxiety in a standardized fashion. In that case, providers can effectively screen and determine who will be most appropriate for a digital solution,” Peiper advised. “The researchers and I are in the early phases of beginning to understand that. Still, this study will help us generate a lot of evidence around how to do that at scale and sustain these efforts once the study is over.”

Editor's Note: This article has been edited to reflect the proper capitalization of Curebase and spelling of Peiper.