OPINION | Apps that guide you through therapy: Are digital therapeutics the future of mental healthcare?

iCBT allows patients to access care 24-7, no matter where they are located.

iCBT allows patients to access care 24-7, no matter where they are located.

Discovery Health CEO Dr Ryan Noach takes a look at the role digital therapeutics could play in enhancing the delivery of healthcare to patients. Using software to guide patients through therapy, for example, has already proven to be beneficial. Could this be the future of mental healthcare?

How do we get evidence-based, clinically validated, and affordable mental healthcare services to many, many more people as fast as possible? Does the answer lie in digital therapeutics, or “DTx”? 

DTx are clinically validated treatments carrying approvals by local regulatory authorities, just like medicines. These tools are accessed through smart devices – and sometimes connected to IoT (internet of things) devices. They must be recommended (think, “prescribed”) by a registered health professional. As patients use DTx, their healthcare providers can monitor their compliance and progress, thereby enriching clinical management. 

Studies show that DTx are effective in supporting preventive care, diagnosis, treatment, management, and improvement of conditions as wide-ranging as diabetes and obesity to cancers, neurological, gynaecological, urinary, digestive conditions, psychiatric conditions and more. 

The clinical case for enhancing healthcare delivery through DTx is driving an emerging business case. According to a McKinsey report, from 2020 to 2021, global digital health funding grew 79% to reach $57.2 billion, with funding for digital therapeutics (including solutions for mental health) growing faster, up 134% to $8.9 billion in 2021.

Other research puts the global DTx market size at USD 4.3 billion in value in 2022, and predicts expansion at a CAGR of 28.36%, to $19.4 billion by 2028. Interestingly, by 2021, around 68% of DTx available, focused on neurological and psychiatric conditions. These developments mean that more and more consumers are able to access very effective mental health therapies on-demand and online. 

Cognitive Behavioural Therapy (CBT) – the gold standard of treatment for various psychological disorders, including depression and anxiety, is usually delivered face-to-face. Internet-based cognitive behavioural therapy – or iCBT – is simply CBT that’s communicated online through written text, graphics, videos, and interactive tools. There is growing evidence that, to treat depression and anxiety, iCBT is as effective as, and also supportive of, CBT delivered face-to-face.

The benefits of iCBT are many, including that it allows patients to access care 24-7, no matter where they are located. Care and treatment can also be personalised to increase treatment effectiveness and outcomes. Research shows that guided iCBT can be most effective in people who have moderate to severe depression. 

As iCBT is a therapeutic tool, it must be recommended by the treating GP, psychologist, or psychiatrist. To offer one example of the power of this sort of tool, the iCBT offered by leading digital behavioural health and wellbeing platform SilverCloud by Amwell has resulted in 56% of users with a clinical diagnosis of depression or anxiety being diagnosis-free at three months, up to 80% of users showing improvement in depression and anxiety symptoms, as well as 65% of users experiencing significant improvement. 

Indeed, digital healthcare technologies have been available for years. Yet, it was the pressure brought to bear by the Covid-19 pandemic to extend access to healthcare through virtual channels to limit the spread of infection that accelerated the uptake of and evolution of these platforms. Now, they’re attracting attention in dealing with another global health crisis – the explosion of mental illness. 

Globally, one in eight people were living with a mental health disorder in 2019 and some studies show the Covid-19 pandemic precipitated an additional 53 million cases of depression and 76 million cases of anxiety. Depression and anxiety disorders are not only debilitating, but also cost the global economy $1 trillion each year. Looking to South Africa, a recent Wits University study found that around one in four people may suffer from depression. Then there’s the problem of reach.

In high-income countries alone, only one-third of people who have depression access formal mental health care. The South African Depression and Anxiety Group (SADAG) reports that locally, only one in 10 people who require mental health support access any form of treatment at all. It’s also estimated that poor mental health costs South Africa in the region of R161 billion a year, according to SADAG. 

Representative of the South African mental health trends data shows that from 2018 to 2022, mental illness increased in prevalence by almost 20% among Discovery Health Medical Scheme (DHMS) members.

Mental illness now affects 13.5% of scheme members and 60% of members are diagnosed with depression – the condition growing in prevalence faster than any other and accounting for 57% of direct scheme spend on mental health services. This is why we’ve explored the option of support for depression through DTx, to complement the mental healthcare offerings provided to scheme members. 

In a world facing unprecedented demand for healthcare services across the board, prescription digital health technologies and DTx herald a really exciting era – particularly in meeting the urgent and growing need for mental healthcare services. I hope to see these tools deployed widely, so extending support and more importantly, hope, to the millions of people who need it.

SilverCloud is licensed by SAHPRA, is CE marked and is FDA 510(k) approved.

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