Why Digital Mental Health is Like the Wild West

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When I talk to people about the digital health space – specifically digital mental health – I often say, “It’s the Wild West!” and everyone nods. But then I stopped to think about what I really mean by the Wild West. I realize that the metaphor holds up very well.

wild west

There is a gold rush. The California Gold Rush began on January 24, 1848. News of the gold brought some 300,000 people to California from around the world. They were called forty-niners in reference to the year the fever really hit, 1949. Tens of billions of today’s dollars in gold was recovered. The gold rush transformed the economy of California and economies all over the world.

The financial opportunity – and temptation – represented by the digital mental health revolution is similarly profound. Americans alone spend over $148 billion annually on mental and emotional health. Moreover, more than half of people suffering from emotional and mental distress will never seek treatment – meaning there is a huge, unmet need. Of these who don’t seek treatment, over 45% cite price as a barrier, and over 40% cite stigma as a barrier. Digital health tools, like mental health apps, address these barriers by being highly accessible and highly affordable. They also have the potential to neutralize stigma because, as I’ve argued elsewhere, mobile devices are the hub of our lives and thus what we do on them automatically gains an aura of “good.”  Digital health therefore represents a perfect marriage between social good and economic potential, and there are plenty of forty-niners who see this opportunity and want to cash in.

There are snake oil salesmen. Indeed, many companies are jumping on the wagon and digging for digital health gold (to keep the Wild West metaphor going). Some of these companies offer great, beneficial products, but others are “snake oil salesman.” Snake oil is an old-fashioned term that tends to refer to fraudulent health products or unproven medicine, but in general refers to any product of questionable quality. A snake oil salesman is someone who knowingly sells these fraudulent products. You see these guys as comic relief in Western movies all the time, usually a traveling “doctor” selling fake medicines, who leaves town before customers realize they have been cheated.

One way for us to get around the risk of snake oil is to elevate the dialog around digital health and develop ways of evaluating the scientific quality of what’s out there, since none of this is regulated (yet). This will help us look past the shiny bottles of alluring medicines that are actually snake oil, and find the real healing agents. Psyberguide is one organization I came across that appears to be trying to do just that.  If we don’t push ourselves as an industry to meet standards, we risk becoming comic relief rather than a true paradigm shift. We also risk repeating the failures of the analog healthcare system, just making them digital.

There are pioneers.  I believe that a science-backed digital health revolution will be the single most important paradigm shift in the failing mental health industry. This revolution will allow people to promote their personal wellness like they do their physical wellness and fitness. It will allow people to access treatments that are effective without being too expensive, burdensome, or stigmatizing. We need to think outside of the box for a true paradigm shift to occur in how people access support for their emotional and mental health – whether that’s the transformation of how patients access their health information through electronic medical records, how health information is collated to lead to better diagnosis and treatment, how health information is gathered through tests done on mobile devices, or how interventions are accessed, through mobile health apps and digital brain training. Pioneers in digital health are rethinking how to empower the individual to promote their own mental and emotional wellness, to use personal health information to actually improve our lives, not just be monetized by big companies mining our big data.

I firmly believe that destigmatizing mental illness and emotional distress will be the linchpin in this paradigm shift. Mental health – when we say those words, we think illness, not health. We think of people being crazy, despondent.  Why is that? It is because Psychology and Psychiatry have failed to make mental health a positive goal like physical health and fitness. When we struggle emotionally, we feel broken. Treatments are burdensome, hard to access, and stigmatizing. We need to be on the vanguard of a paradigm shift away from stigmatizing, expensive treatments emerging from the “if we build it they will come” mentality, and towards a new vision in which people are empowered to personalize their mental wellness through tools that work for them, when and where they want them.

If pioneers brave the Wild West that is the digital health field of 2015, we have a chance of creating something that transcends our humble beginnings to actually make a difference.