Through expanding access to basic care, mental health startups are working toward a healthcare system where prevention comes first

• Startups are using technology to expand access to basic mental health services and preventive care.
• Despite limitations, digital health apps are still helping to chip away at the mental health crisis.
• By even just taking therapy online, these companies are forging a brighter future for mental health.

When it comes to treating mental illness within the broken US healthcare system, few good solutions that suit most people's healthcare needs and budget exist.

Despite a push to destigmatize common conditions like depression and anxiety, the vast majority of Americans still face systemic barriers in treating their mental health conditions. For those priced out of mental health services covered by Medicaid, even the cost and hassle of private or insurance-backed therapy translates into fewer people getting the care that could help them manage their conditions.

This combined need for mental health services is dizzying in its scale and scope. While the existing healthcare system is nowhere near a major overhaul, a new crop of technology-enabled options targeting milder conditions and prevention hope to chip away at the larger problem.

Through online therapy for both groups and individuals, startups like Talkspace and Real are taking a direct-to-consumer approach to facilitating basic, digitally accessible talk therapy.

"We're building for preventative care," Real's founder, Ariela Safira, previously told Insider.

There's 'definitely a place' for teletherapy in solving the nation's mental health crisis

Clinical psychologist Adrian Aguilera, the director of University of California, Berkeley's Digital Health Equity and Access Lab, said the bottom line of most digital health companies is to make the most money, using the scalable aspect of technology to achieve that.

That doesn't always overlap with addressing the country's mental health crisis.

"The system is totally bifurcated and screwed up," Aguilera said, particularly for Medicare and Medicaid patients. At the same time, Aguilera said there's "definitely a place" for teletherapy options. However, just increasing access to mental health providers, even via mobile app, is not enough.

Although the pandemic's relaxed regulations provided "the perfect pressure" test for digital mental health options, a recent TIME/Harris Poll nationwide survey found that although overall telehealth usage doubled, only 5% of respondents got mental healthcare for the first time during the height of COVID-19. This suggests that telehealth expansion didn't necessarily help patients new to mental healthcare into treatment.

"Something my mentor drilled into me is that we currently do not have the ability to meet the need of everyone who wants one-on-one therapy - we simply do not," Aguilera said. "So if we tried to help everybody who needed it, we just could not do that."

What excites Aguilera most are less flashy aspects of digitally enabled mental health services.

For example, in a recent depression study, Aguilera paired texting with in-person group therapy, measuring if an automated text reminder improved attendance and thus treatment adherence. Aguilera and his team found that patients who received the reminder stayed in therapy significantly longer than those who didn't receive a text message, supporting the initial hypothesis of the study.

How mental health startups want to integrate data science and AI into treating depression and anxiety

To what extent venture-funded mental health startups can tackle the worst of the nation's mental health crisis is remains to be seen.

Talkspace, for instance, tends to limit itself to "those with lower acuity," compared to more severe diagnoses like bipolar disorder and schizophrenia, according to a Talkspace spokesperson. However, it does have clients with those conditions.

"We define lower acuity as patients who are able to manage care on their own," the spokesperson said. "For example, they are patients who, outside of occasional episodes, can take care of their family and go to work most of the time."

Others, like Ginger, have a system of mental health services that encompasses behavioral health coaching as well as therapy from a fully licensed practitioner. Ginger in April partnered with Cigna, extending its reach to the major insurer's 14 million members.

Startups are already using advancements in predictive data science and AI to try to better match their patient-users with their offered mental health services.

Brightside, a mental health startup that recently raised $24 million, takes teletherapy one step further by adding medication management and diet and mood tracking components within their app. It also uses past patient treatment and outcomes to recommend new users' best course of treatment.

Others, like Wysa, are aiming to remove humans entirely from lower level mental health services. Its AI-powered chatbot interface, which just raised $5.5 million in May, has 3 million users, TechCrunch reports.

Largely aimed at people who "just want to vent," founder Jo Aggarwal told TechCrunch that Wysa's goal is not to diagnose or treat formal mental health conditions. Instead, it's meant to serve as an additional tool for managing stress around sleep, anxiety, and relationships.

If a user's conversations in Wysa correlate with higher scores on traditional depression and anxiety questionnaires, the chatbot will suggest traditional therapy. Aggarwal said many of Wysa's predictions are the product of over 100 million conversations it's hosted since she started working on it in 2016.

A better future in mental healthcare depends on whatever forms prevention can take

Most of these mental health startups largely work within the existing system, often with large insurers or by using a consumer-first approach that prices out low-income patients. As a result, they ignore the healthcare needs of those unable to pay for their services.

Still, by creating a variety of online options for tech-literate US consumers, the startups are furthering the development of a mental health system that prioritizes preventing, rather than treating, mental health diagnoses.

With the nation's increasing mental health burden, it's a step in the right direction.