Online Support Shows Potential of Tech-Based MH Care, Insel Says

“There has been a dramatic shift in the service economy in the last few years,” said Thomas Insel, M.D., in the lecture he presented at APA’s 2018 Annual Meeting last month. “How people expect to get goods and services has fundamentally changed.”

The field of medicine is not exempt from these changes: he noted that companies like Google and Facebook are betting that the way that people get health care now—through traditional doctor visits and medical facilities—will be changing. Large tech firms invested over $3 billion in health care last year, looking to leverage the power of Big Data and social networks for new health care screening and delivery models.

“From their point of view, why not try and bend the curve?,” Insel asked. He noted that today’s health care, especially mental health care, is constrained by imprecise diagnoses, lack of access to treatment, delays in treatment initiation, and fragmented care. These shortcomings and barriers to care are a shame, Insel continued.

Adding technology to tested mental health interventions could make these treatments work more consistently and reach more people, Insel said. “I call it high tech for high touch,” he said. “It’s like putting treatment on steroids.”

Insel noted the success of the Crisis Text Line, a text-based counseling service for people experiencing thoughts of suicide or self-harm. According to the company’s website, “Every texter is connected with a crisis counselor, a real-life human being trained to bring texters from a hot moment to a cool calm through active listening and collaborative problem solving.” An algorithm used by the company enables messages to be interpreted for severity and triaged to the appropriate professionals.

Another company providing a similar service is 7 Cups. (Insel disclosed that he serves on the company’s board.)

7 Cups is an online and text-message-based peer-support network in which people who want to talk can search for an online “listener” who meets their needs. Some encounters may involve crises but others are on a broad topics—for example, discussions of relationship problems or frustrations. Individuals who complete a listening session are eligible to participate in a short training session and become listeners themselves—thus expanding the reach of the online support community.

While these “listeners” are nonprofessional, 7 Cups also offers online therapy services through messaging and voice options with licensed therapists for a modest fee (for example, $150 for a month of unlimited chatting).

“This whole company consists of 15 people working without a central office, and their therapists served over 575,000 people in California last year,” Insel said. By comparison, psychotherapists working in brick-and-mortar settings in the state served around 480,000 people in same period.

Insel acknowledged that 7 Cups may not necessarily be providing higher quality psychotherapy, but he pointed out that the company does routinely fire psychotherapists who don’t meet quality standards.

And if online methods can deliver effective therapy, the potential could be enormous. Though Insel had referenced several criticisms about traditional mental health care, he did say that one area where psychiatry is not faltering is in the quality of treatment it provides. He doesn’t typically hear psychiatrists tell him they cannot give good care. “They say that they have a lot of barriers to providing care, but when they can give care, it works.” ■