How to Evaluate Digital Mental Health Solutions?

Mental disorders are the costliest medical disorders in the United States, ahead of cardiovascular conditions and injuries. The cost to treat mental disorders skyrocketed above $200 billion in 2013. However, the cost of untreated mental health issues is a silent threat to employers. Depression and anxiety are estimated to cost global employers $1 trillion in lost productivity.

Employers are increasingly aware that mental disorders cause problems in the workforce while negatively impacting the bottom line. In a recent Willis Towers Watson survey, 88 percent of employers reported that mental and behavioral health will become a critical priority in the next few years. Additionally, 95 percent of human resources professionals claim that burnout is crippling their workforce. As such, more organizations are implementing treatment for mental disorders as part of their employee benefit options.

In making mental health care more accessible, employers are turning to digital mental health solutions. Approximately 25 percent of employers have implemented telemedicine and almost one-third plan to implement digital solutions/apps within the next few years.

However, employers should not turn to telemedicine or other digital solutions blindfolded. They should carefully assess what they aim to achieve and how these solutions will help them get there.

So, what should you look for when evaluating digital mental health solutions? Here are six things to consider.

1. Clinical Validation

Did you know that less than 1% of mobile health apps are validated in clinical trials and that many digital mental health solutions don’t have much evidence of true benefit? Don’t just rely on engagement metrics or literature stating that evidence-based therapy modalities are used. These are important factors but dig deeper to figure out exactly how the solutions will impact your employees. At worst, non-professional mental health care can lead to worsening of the patient’s condition.

Even if you are not an expert in validating the clinical efficacy of a given solution, there are simple questions you can ask from your solution provider or vendor to validate if a solution can really benefit your employees:

1. Are you measuring a metrics tied to mental health outcomes?

For example, there are clinically validated scales for measuring depression (for example PHQ-9) and generalized anxiety (for example GAD-7) .

2. Are you conducting clinical trials to show the efficacy of your solution? Have you published your results in a peer-reviewed journal or do you have your manuscripts available?

Ask if the clinical trials are registered at a clinical trial registry, such as clinicaltrials.gov, where the outcomes measured are clearly defined.

2. Ease-Of-Access to Care

How accessible is mental health care for your employees? Currently, only 41 percent of adults suffering from mental health disorders receive help. Almost 37 percent of adults suffering from anxiety disorders receive treatment. Less than 20 percent with moderate depression seek help.

To improve access to care, most companies offer employee assistance programs (EAPs). Ninety-seven percent of large companies with more than 5,000 employees have EAPs and 80 percent of companies with 1,001–5,000 employees have EAPs.

Although research indicates that EAPs can help some employees, many issues swirl around these programs. The main concerns include low utilization rates and lack of privacy.

3. Anonymity

If employees have an easy access to mental health care, do their identities and concerns remain confidential within the treatment? As mentioned above, many employees fear lack of EAP privacy. Employees worry about being singled out, terminated, or held back from promotions as a result. Additionally, employers worry about possible discrimination suits if affected employees are disciplined. According to a recent study, employees wish to get anonymous access to digital mental health interventions that are strictly confidential. If the offerings for mental health care are not fully confidential and easy to use privately, employees are less likely to use them.

4. Licensed Medical Health Care Professionals

Would you trust an app or a coach to evaluate your physical medical conditions? Mental disorders are medical conditions and in many ways comparable to physical ones. To provide high-quality mental health care for your employees, it is evident that licensed medical professionals are providing care.

However, the studies show that you don’t have to see these professionals face-to-face. A recent systematic review on guided internet therapy programs for depression and anxiety disorders showed that therapeutic alliance (the relationship between the therapist and individual) can be even stronger than in face-to-face therapy. This is not that surprising as digital mental health solutions can facilitate more frequent and easier access to licensed professionals.

5. Return on Investment

On average, every one dollar contributed to evidence-based mental health treatment, a four dollar return on investment occurs with improved employee health and productivity.

However, every company is different and there are practical and validated scales for measuring the return on investment. One such example is the Work Productivity and Activity Impairment scale (WPAI). Also, the clinically validated treatment outcome metrics such as PHQ-9 and GAD-7 can be tied to economic outcomes. There are online tools and calculators that can help you to estimate the ROI for your employee population.

As usage metrics and clinical & economic outcomes can and should be measured, it’s worthwhile to challenge the traditional “pay per employee per month” model and tie the actual investment to actual outcomes & usage. Why should you pay for something that is not effective and that people don’t use?

6. Side Effects

Most people in the US are treated with antidepressants. Contrary to common belief, anti-depressants are not that effective and they come with a lot of side effects. Only one out of three people respond to the first prescribed antidepressant while 55% one or more get bothersome side effects, some of which are very severe. Medication is crucial for some, but as an employer, it’s important to consider providing access to licensed mental health professionals who can help people recover without the bothersome side effects.

In summary, digital technology offers numerous benefits for providing access to care for mental health disorders. It’s often less costly than traditional face-to-face methods, warrants confidentiality, and helps streamline human resources processes. However, make sure you’re asking the right questions when implementing these benefits. Educating yourself about the medical validity and the return on investment offered by a digital mental health program will improve both your employees’ health and your bottom line.

Kristian Ranta is the Founder and CEO of Meru Health. He has a long history in healthcare business, having built two successful companies prior to Meru.
Kristian lost his oldest brother to suicide, and now he is building a Meru as an effective and accessible mental health solution to help those who are suffering.