Designing and Scaling Mental Health Products | DHI Roundtable

by Florencia Pieroni

Context of digital mental health

Digital mental health is advancing at top speed, and we need to stay updated on the latest needs of all stakeholders. Together with the Newsletter "Digital Health Insider", we hosted a roundtable with top industry leaders that shared their views regarding "Designing and Scaling Mental Health Products".

This panel of experts was composed of the following:

We will deep dive into different points within the Designing and Scaling Mental Health Products Topic, such as - design strategy, creating products for both customers and clinicians, leveraging VR and AI, taking MVPs to full scale, ensuring health equity, and more.

Read the main insights we shared below:

Why is it that the diagnosis of depression and anxiety keeps racing year after year, mostly among teens and young adults?

Evans Rochaste mentioned three key points:

  1. Post-pandemic anxiety and stress are a thing, especially among young adults. Human connection is essential, and young adults were used to socializing, but then, with the pandemic, they immediately, almost overnight, stopped it. So, the increasing loneliness and isolation are leading to increased depression and anxiety.
  2. There is a lot more pressure now. When you think of academic performance and what we expect from young adults, society's pressure on them is also increasing—day by day.
  3. The macro-environment and social media contribute to this, too. You combine that with other stuff in the ecosystem, and you will see other vulnerabilities a young adult can have, such as other family members who may have anxiety and depression.

Mohsen Omrani also mentions that the diagnosis of depression and anxiety keeps racing year after year, mostly among teams and young adults, because our education is not moving at the same speed as our technology. He mentioned: “We are talking about AI right now, we are all about Chat GPT and what it could do, but we still don't have any regulations”. The same thing happens, for instance, for the teens: they came into a digital age without having enough resources, and even less in the medical sense (to be fair, there were not enough resources even before that). Mental health scars resources in many places and the lack of education and resources are what actually are causing this.

Many people attribute the rise in mental health problems, mainly among the young, to the extensive use of technology. But Alex Stried accurately explained that we still can leverage technology to create the opposite effect, for example, by developing and testing apps from everything around managing medication, teaching coping skills, and predicting when someone may need emotional help, among others. So we are starting to see more of this pop up in space, using technology for good to help people through all of their health needs.

Telehealth benefits to mental health

According to Mackenzie's recent report, there is an x38 increase in the use of telehealth platforms compared to the pre-Covid baseline, so why are people still sticking to Telehealth, and what benefits does it bring specifically to mental health?

Evans Rochaste shared a couple of reasons:

  1. Telehealth overcomes geographic barriers. If you're in one of the care deserts and are looking for a provider who looks like you and specializes in substance use and abuse, for example, it can be extremely challenging to find them and be able to provide that care.
  2. It offers greater flexibility and convenience. Patients can better adjust their times and have their appointments without being in a rush or stressed, which can be associated with more engagement in the processes and, thus, better outcomes.
  3. Helps reduce stigma. Sometimes, having a telehealth option helps someone start their journey sooner than if he would need to go in person. Doing something in your own home may be the difference between starting a journey six months sooner and all the results it implies.

Using VR to leverage patient's experience

There are different benefits of in-person treatment, specifically for mental health. It feels more personal, more human, and more engaging. Can we leverage emerging technologies like VR and AI to get the best of both worlds?

VR it's a technology that allows the recreation and the simulation of environments, shared Emilio. "I think that we are surrounded with an environment that may not be the best, and sometimes with just telehealth (2-dimensional technology), it is not as easy as transporting the person into a better setting". He shared that we need them to understand what's happening and their feelings in that specific situation due to their reality. With VR, we can emulate what situation, take that person closer, make them feel that they are in that situation, and control the environment. So, any triggering situation that happens there is in a more controlled environment. That's unique. We are not going to be as powerful as we could be in person, one-on-one interaction as it's what makes us human, but what we can do in Virtual Reality is leveraging these simulations is something that can really get us closer.

Closing the gap with AI: the big opportunity Artificial Intelligence brings to the health tech industry

Indeed, Philippe Cailloux added that there's a great opportunity for AI between visits where there's a big gap in this presence and the bond between patient and provider is broken or is distant. AI is being used and productized in extending this bone outside of the sessions, and all the applications to support the programs and maintain the engagement that has been developed help strengthen relationships between the patient and provider.

"There is a necessity for humans to be in touch, but it doesn't mean that humans should do everything, and there are lots of tools that we use to increase their productivity," stated Mohsen Omrani. We believe in having a clinician providing feedback to the patient where the patient feels accountable that somebody sitting there is a professional listening to what they say and caring about it. But Omrani shared that we can still make it easy for a clinician. Indeed, there is stuff that we know the algorithm can do that a clinician who has 20 years of experience could do, for example, predict patient dropout. A clinician who has worked for 20 years has that intuition and can tell you, but now, we can collect this information using AI. We can use it to incorporate that intuition into something formulated so that somebody who came out of the school yesterday can also have access to the insight that a 20-year experienced clinician can have, Omrani shared. So, there are a lot of ways that AI can help with this.

Building Mental Health Products

Building comprehensive solutions for patients and clients

Most telehealth solutions have two types of users:

  • The patient.
  • The provider.

Still, most of the solutions focus on the patient's experience, leaving the provider aside. So, how can we build a comprehensive solution for both parties? By treating our providers as customers, Alex Stried affirms. She deep dives into the importance of making sure that providers have tools that are easy and friendly to use. You want to ensure that the jobs they're doing outside of their sessions with their patients (tracking payroll, taking notes about a session, among others) are as easy as possible. We want to streamline those experiences for them. Why? Mainly because if we have a disgruntled provider going, "Oh, gosh! This error again", it goes directly on to the patient and may affect their treatment, and we don’t want that to happen. We want that experience to be all about the patient and nothing else. So, we must remember that as we build products for the providers.

Also, Stried mentioned the importance of the data for the clients. "We collect so much information after the sessions that we want to make sure that we are using it in a valuable way and providing it back to the client for their treatment". Remember, sessions happen once a week, but patients deal with mental health issues 24/7. We need to make sure that we're using tools that allow the data we collect in the EMR to be passed onto the client so we can treat them holistically.

Leveraging IT healthcare to maximize the efficiency of treatments and facilitate evidence-based, rigorous clinical approaches

We can focus on healthcare software development and leverage products to maximize the efficiency of treatments and facilitate evidence-based, rigorous clinical approaches with two things, Mohsen Omrani stated:

  1. When designing technology, always look into clinical validation. It's important to remember that mental health is health, and in the same way, we do not expect somebody to wake up in the morning and come up with a new way to do heart transplants. We shouldn't expect anything like that from a mental health app, either. What you are designing should be validated, and you should go through a rigorous trial to ensure that you are not doing any harm and actually improving their mental health.
  2. By helping clinical validation. The challenge with mental health is that a lot of mental health is stuck in 7 years ago, he mentioned. Mainly the most significant advancement has been what is being called "from room to zoom": we do exactly what we did in person now through Zoom, and that's not really the progress. The progress needs to be in different ways of collecting the data, engaging, and treating patients. We can use technology to increase access, increase engagement, and improve outcomes. Now, instead of just relying on some qualitative explanation from the patients of how their treatment or process is going, we have tools that we can evaluate and exactly look at the patient's pattern of sleep or pattern of activity, which could be really important for understanding many situations, for example, a relapse. We need to incorporate as many technologies as possible to improve the quality of care as it's been done throughout the rest of medicine.

Challenges of creating empathy in underserved populations with digital healthcare products

Empathy in the relationship between the patient and the provider is crucial, and we can make different product decisions to boost it and help patients heal and thrive. Shohini Gupta shared that the secret to their success firsthand has been that they employ a lot of "I've lived it'' experience. This means realizing that there are no great ways to understand what someone has been through without going through it yourself. Thus, they employ people with that lived experience rather than assuming that you know what that feels like to reach better to patients.

Likewise, it's important to know that often, peer recovery specialists who, for example, have a severe mental illness (whether it's bipolar or schizophrenia) may not actually even find employment in other places when, from a company perspective, having lived and recovered from that experience it's actually a superpower. Companies must put a ton of effort into supporting a workforce that might have more diverse needs in that way.  

We need to remember that what happens in a session is such a small part of someone's experience in a mental health system, highlights Evans Rochaste. Especially in under-represented populations, there are so many cultural, social, and economic challenges that they're experiencing, so providing that support outside of the session is really important. He mentions, "If I don't know where I'm going to get my next dollar from, I'm not going to be able to come to a mental health session, right?"

Another aspect to consider is cultural competency. Rochaste explains that having providers that look like the population that they're serving is also really important. So combining those two aspects is how they've seen the greatest success.

Finally, Shohini Gupta highlights the importance of getting feedback to ensure you are on the right track with your product. Doing a ton and ton of product feedback internally ensures that you are serving them in the way they need and designing tools given their conditions and necessities.

Key Differences in Building Healthcare Products and Mental Health-Specific UX Considerations

There are fundamental differences between building a healthcare product and one for other industries. Philippe Cailloux deep dives into them from a high-level approach, in case you are not in the healthcare industry and are planning to build something.

For example, imagine that you work on a startup that creates a PTSD (Post-traumatic stress disorder) management product for providers and their clients; Cailloux highlighted five potential project challenges for that:

  1. The team challenge. Imagine having a first-time Clinician CEO, a low-empathy engineer, a prominent business person, and the product itself. Here, they lack human psychology and cross-control skills, and that's game over before you even have a chance to sell.
  2. The user research challenge. Health care could be more friendly when it comes to iterative development. It is essential to inform the development of all the patients’ and providers' insights. Cultural differences are super important, and it is tough to access patients and providers, especially simultaneously. The worst trap would be to think that clinical expertise can replace user research. It just does not work.
  3. The regulatory challenge. There's a fine line between a regulated and a non-regulated product, especially with the moving target from Covid-19. So if you don't pay attention, the project will become very long and expensive quickly. HIPAA could be a trap because many providers have implemented stricter policies than HIPAA. You look at HIPAA and think you are good, but you go by the provider, and they say, "Oh, not enough. I'm not going to do it".

4. Adoption challenge. So even after you have a successful pilot and validated safety and efficacy, getting the providers to adopt a new tool is not easy, and for the patients to actually stick to a digital solution can be even harder than simply taking medication. You cannot beat the pill even if you have a clever incentive mechanism.

5. The revenue challenge. So you went through all the previews listing. Now you have your product. Who's going to pay for it? Very different from the other industries, the patients, the providers, and the payers, none are willing to put their credit cards on the table. To overcome these differences, there are three healthcare-specific challenges:

  • A strong interdisciplinary collaboration.
  • Empathy-driven design process
  • A strong understanding of the clinical and regulatory landscape.

Using technology to measure the patient's progress during treatment objectively and efficiently

Another essential part of healthcare products, specifically in mental health, is measuring how efficient the treatment is, but sometimes it's a great challenge to measure efficiency when dealing with mental health. So, we can measure the patient's progress during treatment and use digital healthcare software to make it more objective.

Alex Stried shared that at Cerebral, there are specific assessments that their clients take monthly. Patients can send those results to the clinician for him to evaluate them. They can also go back and forth through its app to see the progress throughout their treatment. Fortunately, many options, such as mood trackers and journaling, use machine learning to showcase back results to patients.

But it's important to remember that it is a trade-off situation. Emilio Goldenhersch mentioned that the more accessible and affordable founders want to provide services for underserved or uninsured populations, the more difficult it becomes to add the buyer markers or a different gadget to measure, such as a Fitbit, watch, or even breathalyzer. So the more we want to be more specific and accurate in measuring progress with different gadgets, the more expensive it becomes, so fewer people can access it.

Measurement is the key to objectively and efficiently tracking patient progress during treatment, but "the reason that we are stuck in the last 70 years, in my opinion, is the lack of measurement," affirms Mohsen Omrani.

The previously mentioned expert stands that the basis of mental health and medicine is evidence-based practices, but, for instance, in depression, the efficiency of many medications for depression at best is around 50%. The challenge is not whether the medicine doesn't work; it is that we are bulking a lot of patients with different symptoms and diseases and are trying to address all of them with the same medication. Following the example of depression, depression is not a disease; it is a compilation of symptoms with multiple underlying causes, and we cannot put various under the same name and try to address them all with the same medication. Omrani mentioned: "The only way we can move past where we are and where we have been over the last 7 years is to implement meticulous measurements that can separate them". This doesn't mean that all kinds of measurements should be technology-heavy—for example, having sources that can use natural language processing (the primary source of information that the clinicians use for diagnosing patients' problems and coming up with the treatment) in a scalable and low-cost way. The measurement should be at the forefront.

Getting to the root of mental health conditions to treat them more efficiently

The brain is too complicated, and we are not going to solve the brain anytime soon, but we could still do measurement-based products. Omrani pointed out that instead of calling everything depression, we can look at it, try to break it down into different categories, and see that there are probably ten buckets. We will find that the medication works for bucket one but not for bucket 3. We must collect big data, focus on measuring, and focus on the outcome. It's quite a complicated challenge that nobody will solve alone, Omrani stands. "The only way is for us to combine different technologies and to combine different data sources and to combine the outcomes to be able to do this dissection and come up with the best solution." We need to add more granularity to the conditions for more personalized treatment for each patient.

Scaling Mental Health Products

Defining the best model for startups to scale their products

​​Many startups start B2C, but customer acquisition is slower unless you spend millions on marketing. An alternative is B2B2C, which requires health plans to cover your services. Nevertheless, this is not always easy to get. Many health tech founders struggle to get coverage by health plans, so Alex Stried shared that the first thing to do is understand the differences between the various types of health insurance and then understand your target audience and why you would target one of those particular types. Another critical factor she mentioned is to "make sure that you're finding the decision-maker (probably the CEO or someone on the executive team) and getting in that way."

Another interesting point to take into account is the Direct to Employers Model. Alex Stried shared that it is easier if you have a product offering that employees are really interested in, and that is the simplest way to get them to pay for that service out of pocket. In this way, you will be able to eliminate the middleman there.

Evans Rochaste explained that collecting data from Day 1 is extremely important. Data compiles, and the longer you have data, the better. Collecting data could be a series of cohort studies on Day N°1 as you get more and more users or patients, as data will ultimately be how you will paint your picture. He highlighted the importance of deeply understanding the complexities of the healthcare system and behavioral health. "Focusing on the data and being able to present and find the champion decision makers to move through this stakeholder landscape would be my best advice," Rochaste shared.

Patient proximity and continuous care while optimizing the most expensive resources to remain profitable

Another common challenge of health or healthcare platforms is providing excellent service and patient proximity while simultaneously optimizing the most expensive resources, such as providers.

We can offer patients continuous care while remaining profitable by having providers practice top license, affirmed Evans Rochaste. Every single task is being tasked to the right person, so our providers are not doing tedious paperwork or doing things that are taking them away from the decision-making. It is essential to keep costs down. Now, with the advances in technology, we have to leverage AI and different models to help automate processes (payments, back office, front office). The digital health front door helps keep costs out. So, "leveraging the beauty and the advances of technology and having providers practice top of license is probably the two biggest ones that we have been leveraging," said Rochaste.

Also, Alex Stried added that looking at the data is essential as you start to think about how to set up your clients or your patients for success at a company. Looking at the data, you will find out opportunities to focus on. For example, by doing so, they discovered that patients that came in and went off to a solid start with their treatments were more likely to see success on the plan, so now they have a growth hacking team that is fully dedicated to getting people to a good start. How? They got this patient proximity and continuous care while optimizing the most expensive resources to remain profitable with push notifications, emails, reminders, etc.  

A second point Rochaste mentioned is that we have to ensure that the providers have tools and focus on giving your clients tools to get this proximity and scaling. Ensure they have everything they need to avoid contacting customer support to find out.

Thirdly, she mentioned that having the right amount of W2 employees versus 1099 employees is very important to achieve patient proximity and continuous care while optimizing the most expensive resources to remain profitable. Aside from just servicing clients, things will always happen and end up being full-time jobs, and you don't need as many of them at a certain point. So, "changing the payment model of physicians, I think, is another thing to look at to ensure that your ratios are correct," Stried affirmed.

Ethical boundaries while designing products that use human psychology strategies to leverage patient engagement

We often leverage human psychology to build habit-forming products in every marketing or product decision. If we can use these "tricks" to make patients engage more and thus adhere better to treatment, we do it with a good purpose. But where is the ethical boundary?

The key word here is "purpose." Emilio Goldenhersch mentioned that the "ethical boundary is on the founders, on the people who design this kind of products, and it is our job to understand the needs of our patients and who will be using our products." Something he highlighted from the healthcare industry is that we're all about pushing the boundaries of IT for good, "we are not becoming an entertainment app where the boundaries are not so clear." So, when we design apps, understanding the patient is very important. We need to know when or how to leverage these triggers internally and externally to make them back on their own path to improve their lives.

The marketing tricks work in consumers because they leverage natural needs, but in healthcare, Cailloux mentioned, "I've not been able to get traction from many different angles. The only one, unfortunately, is micro task-based financing incentives. Anyone getting the industry uses various tricks to hook people on Facebook and believes it will work in healthcare; it doesn't.”

Human Connections and effective collaborations in the healthcare industry

Human connection in the health tech world

How can the tools that we are working on actually increase the efficacy, but also without neglecting the human-to-human connection? “We all aim to enhance one-on-one intervention as it is impossible to replace the contact of a hug with any technology”, Emilio Goldenhersch shared. If we have access to one on one interventions, it means that we are privileged people. Many people don't. Technology brings forth that opportunity to close the gap and get us closer to that. We have Artificial Intelligence, Telehealth, virtual reality, and many more to come that allow this.

Make collaborative efforts effective for all stakeholders: doctors, patients, and others

Shohini Gupta mentioned that much of the collaborative opportunity here is making dense amounts of information understandable and easy to read so you can share it across as many surfaces as possible. “Ultimately, it's complex individuals who might have multiple chronic conditions, multiple mental health conditions, and making sure all of their providers are actually on the same page is one of the hardest things." So it's less about the technical challenge of big data and more about how you get it in front of people. Are you doing it consistently? And are you doing it in a way that is actually legible to the provider? "It is more about the effort of actually putting in the time to do it and thinking about the providers," she mentioned.

It was a thrilling experience at this roundtable with experts on the panel and valuable insights on each topic. It emphasized the importance of collecting and organizing data, which enables informed decision-making and frees specialists from tedious and easily automatable tasks. This not only saves resources but also enhances business profitability. Furthermore, it highlighted the significance of attending to the service provider and the customer, recognizing the importance of a balanced approach. Lastly, forming alliances with healthcare SAAS companies with a solid know-how, understanding of the market trends, and industry specifications can serve as a strategic move to create products that significantly add value to users delivering exciting experiences for patients and providers while remaining profitable.

Check out the full recording here:

Watch the full roundtable on our YouTube channel.

Designing and scaling mental health products | Light it | Digital Health Insider | Roundtable