There has been a profusion of digital mental health solutions as incumbents look to raise their profile and start-ups seek traction in the post-pandemic world of digital interaction. Kelsey Rees looks at the expanding market and the potential winners in the race to command the digital mental health space
Online mental health services have long been a niche segment of the digital healthcare market. Indeed, computerised CBT is something of an old timer when it comes to digital platforms. Back in early 2007, long before Babylon et al sought to increase GP access through online consultation, the NHS rolled out two computerised CBT programmes, Beating the Blues and Fear Fighter, as part of the bid to increase access to psychological therapies.
Since then, the market for digital mental health services has grown though perhaps not as rapidly and with the same fanfare as other digital health solutions.
Luke James, medical director of Bupa Global and UK Insurance, says the adoption of digital mental health services has been slow, with relatively few providers offering virtual or telephone therapy and limited numbers of customers taking it up.
However, he reports that there has been a massive upsurge in demand since the outbreak of Covid-19 as quarantine forced consumers to change their habits, creating an unprecedented rise in digital mental health use across the market.
‘We expect a 50% increase in mental health claims in Q4 compared to last year and pre-authorisations for mixed anxiety and depressive disorder are up by 16% this year, so you can see there’s a huge wave of this coming through,’ he said.
According to James, Bupa’s direct access mental health service, which allows customers to access support without waiting to first see a GP, saw a 44% increase in demand in September this year compared to September 2019.
A similar upward trend has been reported by digital mental health provider SilverCloud, which delivers approximately 75% of the coverage for NHS IAPT (Improving Access to Psychological Therapies) services and reported growth of roughly 15,000 new users a month around April.
‘We’ve seen a steady increase year-on-year in terms of the use of SilverCloud across the NHS but also in private providers and insurance companies,’ said Dr Lloyd Humphreys, the company’s head of Europe.
And as expected, take-up of SilverCloud’s services has exploded during Covid with a fourfold increase in user activity.
‘So that fourfold increase was right in the heart of that period where the reliance on digital became really important. And that was at a time where referrals were decreasing, so the number of referrals from GPs from other parts of the health system into mental health were decreasing. So, the referrals dipped in one month by up to about 57%. Whereas we increased our usage by several hundred percent. Obviously that spike in usage has come down, but it’s not gone down to wherever it was,’ Humphreys added.
However, evidence is also emerging of a shift in demand away from mental health apps and towards lifestyle and wellbeing advice as the Covid-19 pandemic took hold.
ORCHA (Organisation for the Review of Care & Health Applications) is a health app evaluation and advisor organisation and is part of the NHS England National Innovation Accelerator Programme. It assesses health apps and provides users and healthcare professionals with an online library to help them find the best applications to address specific requirements, including comparing and evaluating similar apps with an assessment of benefit and value, and more clarity on any risk associated with their use.
In its Covid-19 Quarterly Digital Health Trends report, it found there was a 60% decrease in mental health app searches on its platform from 2 March to 10 August. While search terms which saw an increase included health living (850%), healthy eating (385%) exercise (354%), weight (218%) and diabetes (168%).
‘It’s interesting because it’s almost like a barometer that tells you what people are worried about. There was a lot of fitness and getting healthy. And then obviously supporting vulnerable communities who live with long-term conditions,’ said Liz Ashall-Payne, founding CEO of ORCHA.
‘If you think about the messaging that came from our policy leads, it was all about get yourself healthy and be as healthy as you can in case you get the physical disease. There was a big focus on people living with certain physical conditions like diabetes, COPD, asthma. It was very much physical focused to ensure people stay healthy as the condition continued to stay prevalent and impact on people’s ability to maintain a healthy and active lifestyle,’ she added.
The investor landscape
Investment in the digital mental health market has been steadily increasing over the years but has begun to accelerate during the past nine months.
In April, SilverCloud raised £13m in a Series B funding round, while online mental health services provider Kooth raised £26m in September through admission to the AIM market.
Psyomics closed a £1.5m funding round in October to bring its mental health assessment and diagnosis platform, Censeo, to market.
And, stress reduction app Calm raised £22m in July 2019, having achieved unicorn status at the beginning of the year with a £70m fundraise.
According to research from Octopus Ventures published earlier this year, 108 deals with a total of 106 investors have taken place in the UK digital mental health market since 2014.
A total of £21.27m was raised for digital mental health in the UK in 2019 – a significant increase from the £350,000 raised in 2014 but still a small proportion of the £580m global total, which has risen almost five-fold since 2014.
According to LaingBuisson consultant and Digital Health report author Martin Bell, a possible barrier to increased investor activity in the digital mental health space could be a lack of a focused product.
Bell believes that some providers, such as Calm and Sleepio, could have an advantage in the market because they are targeted to a very specific need.
‘The challenge for investors is, if you’ve got a very targeted product that you can mentally equate to something like a fitness app or a heart rate monitoring app, if a mental health app can be that clear, then I can see them getting investment,’ he said.
‘But mental health isn’t like that. Physical health can be enormously complex of course, but there’s a lot of physical health that is pretty straightforward. Whereas, there is a natural complexity to mental health that I think isn’t there in a lot of physical health. Investors will ask “so who’s going to pay and how do I get a return on my investment?” I can understand why there’s been less investor activity in the mental health space.’
Ashall-Payne echoed these thoughts, suggesting that due to the complexities of mental health, targeted products could have more success in the market.
‘I think if you are very specific about who you’re targeting then you will get more traction. And the reason for that is because we’ve created a product for a very specific requirement or a very specific demographic profile. As such, those users will then continue to use that product and get benefits from it,’ she explained.
According to Ashall-Payne, generic mental health apps could never provide an immediate solution to the mental health needs of the population. This lack of specificity means that even if many people make the initial download, they soon realise it’s not right for them, delete it and move on to something new.
‘The best analogy in this instance is the world of drugs,’ she says. ‘We don’t just have one antibiotic; we have lots of different antibiotics for different infections or different people. And that’s what we need in the world of digital health.’
It is becoming increasingly clear that beyond Covid, providers will need to expand their services in order to respond to the changing digital habits of consumers. Going forward, it appears that one of these trends will be services focused on helping users maintain or transition to a more healthy lifestyle.
Dr Keith Klintworth, group COO and managing director at PMI provider Vitality told HMUK this was a key focus given the proven mental benefits people can derive from exercise.
‘We know exercise, irrespective of where you are on the continuum of mental health is a great treater and preventer of mental health and great promoter of mental wellness. Then you start with your digital journeys, which enable scalability, self service, self management, without relying on a health system to help you with your problems,’ Klintworth said.
‘When Covid came, and we promoted home exercise, nutrition, and mental wellbeing, we saw a 40% drop in authorisation claims for mental wellbeing off our baseline, and what drove that I think were the number of really good benefits that came out of Covid. As drastic and as horrible as it was on society, it definitely created more of a community and more family time and the ability to connect, together with increased exercise.
‘I can’t stress enough how engaging in exercise and healthy nutrition still remains vital.’
Fellow PMI provider Bupa is taking a similar approach, as James explained.
‘We’re absolutely looking into that digital space in terms of digital wellbeing apps and things to build resilience. We’ve got a big digital agenda at the moment. Hopefully, where we’re moving to in the next 12 months is a much more preventative approach, such as how to look after your mental health,’ he said.
SilverCloud is also looking to expand its services, taking on a population-based approach.
‘Now people are seeing where else digital mental health can be used. They’ve seen it has been effective during the crisis so now different services are seeing where it might apply,’ Humphreys explained.
‘For example, SilverCloud is now being used by school clusters across Yorkshire, in universities, we’re used by class substance misuse services, drug and alcohol services. We’re looking at probation services. We just started to work with housing associations, so we can see that the use of digital now is getting more widespread. We can see the movement towards a much more population-based approach.’