Digital mental health is booming. Declining social stigma and the dramatic increase in demand of recent years have collided head on with the high barriers people have always faced when seeking traditional, in-person care. Given such a fundamental disconnect between supply and demand, private investors have been quick to seize the opportunity for innovation, as well as for profit.
Direct investment into mental-health startups skyrocketed to over $5 billion annually in 2021. Favoring a largely virtual-only approach to care delivery, this new wave of companies promised streamlined access to care; however, skepticism surrounding the quality of the care being provided has always been lurking in the background.
A Cause for Concern
Several digital mental health companies have recently come under fire for issues related to overly ambitious scope of practice, lack of supervision/support for nurse practitioners, and an inability to respond to patient questions in a timely manner. Notably, Cerebral, a SoftBank backed tele-psychiatry startup, was the subject of multiple federal probes from the DOJ and FTC, whose investigation into possible overprescription of stimulants resulted in the replacement of its CEO.
John Oliver, host of HBO’s acclaimed Last Week Tonight, recently detailed how digital mental health startups have increased access but fallen far short in implementing quality programs at scale. All of this explosive negative coverage has threatened to erode public trust in mental health startups and their ability to solve the access problem in a quality way.
It Doesn’t Have to Be This Way
Through both our clinical practice and experience in multiple mental healthcare startups, we have seen first hand that it’s possible to implement effective clinical-quality programs that put patient care first while still driving bottom-line impact.
In this article, we outline best practices that we hope will serve as a useful model for improving industry-wide quality moving forward.
First, let’s address the elephant in the room: measuring quality in mental health is hard. Mental health as a field suffers from limited diagnostic precision given a lack of biological or laboratory values to aid in diagnosis and monitoring of outcomes. In addition, much of our work is subjective. Helping an individual improve their own experience of life is wonderful and rewarding, but it is also maddeningly difficult to measure and track.
These challenges are no excuse for a relaxed attitude toward clinical standards. In fact, the recent influx of private capital makes now the perfect time to invest in the clinical policies, technology, and infrastructure that can actually enable digital mental health platforms to deliver higher quality interventions consistently, and at scale.
What does it mean for a mental health startup to be “high quality”? A few Ivy League advisors on the company website is no substitute for clear guideposts that signal that quality is part of your digital mental health practice’s DNA. To that end, we suggest seven steps to companies looking to ensure their clinical compass is pointed in the right direction.
7 Steps to Higher Quality
- Appoint a licensed, practicing mental health clinician to the executive team and give them a say in strategic business decisions.
- Include at least one clinical metric as a key performance indicator (KPI) to be reviewed at all board meetings.
- Establish evidence and/or guideline-based clinical policies. (Ideally from day one, but it’s never too late!)
- Measure clinical outcomes using validated metrics (e.g., PHQ9, GAD7, etc.)
- Hire only thoroughly vetted providers (e.g., board certification, National Practitioner Data Bank, background checks, no adverse licensure actions)
- Ensure physicians supervise master’s level practitioners (e.g., NPs and PAs) by instituting required chart review, regular meetings, and responsiveness to questions.
- Invest in an ongoing training curriculum and learning tools (e.g., conferences, speakers, continuing medical education, decision-support) to ensure all clinicians continue learning the latest in their field.
For those shopping for mental health services, these are the crucial elements you should be looking for as you evaluate potential providers. Payors and employers can use these steps as a checklist to ensure they’re bringing high quality mental healthcare into their network—doing the vetting their members have every right to expect.
It’s Time to Take a Stand
For all digital health companies, the time to focus on clinical quality is now. It is incumbent upon us as providers to take a stand for clinical quality. Investor pressure and business expediency must never be allowed to compromise our core mission—expanding access to quality care that is safely monitored, evidence-based, and clearly measured. The tools and resources to make this happen are within our grasp.
We hope the steps we’ve outlined above provide a solid foundation for companies looking to avoid the mistakes of the past and head off new breaches of public trust in the future. We’ve come too far to let our patients down now.
About the Authors:
Ravi N. Shah is the Chief Medical Officer of Geode Health and co-founder of Mantra Health.
Prateek Sahni is a medical student at Columbia University and Business Development and Strategy Associate at Two Chairs, a California-based mental health startup.