Nurturing a Mental Health Tech Menagerie: From Unicorns, to Camels, to Cockroaches and Gorillas
We must cultivate a global ecosystem of new and effective mental health solutions. These solutions need to be culturally relevant, ethical, evidence-based, and their development must be globally applicable. Can you think of other entities for our mental health tech menagerie?
The mental health field is clearly in desperate need for new and improved solutions for a diverse set of problems. These solutions are essential to optimize access, screening, diagnosis, treatment and prevention and are required across the world in low-, middle- and high-income settings. Fortunately, there is a tremendous amount of interest in, and opportunities for, new technological approaches to addressing these challenges.
Venture capital investors have recently made record-breaking investments in mental health, with USD $637 million invested in more than 60 different mental health supportive companies. This is almost 23 times the investment in 2013. The companies Lyra Health and Calm have both just reached valuations of more than $1 billion, making them the first “unicorns” in mental health and beacons of potential for mental health innovation. A “unicorn” is a privately held startup company valued at over $1 billion. Indeed, over 800 investors have funded mental health startups. We wish to express excitement at these major financial milestones; however, we call for a diversification of thinking about how and where mental health tech advances arise.
The Mental Health Tech Menagerie
We wish to introduce the concept of an ecosystem of a “mental health tech menagerie”, consisting of diverse interdependent entities which all play a critical role in the global mental health tech ecosystem. Examples include “camels” (models which emphasize sustainability and adaptability in diverse circumstances) and “cockroaches” (companies which emphasize resilience and survival), which were introduced in Alex Lazarow’s recent book, ‘Out-Innovate: How Global Entrepreneurs from Dehli to Detroi Are Rewriting the Rules of Silicon Valley’. These are described below in table 1.
Table 1: Entities of the Mental Health Tech Menagerie
Critical Needs in Frontier Markets
In progressing mental health innovation across the globe, we can learn much from supporting emerging ‘frontier’ markets and entrepreneurs, who are thinking creatively about raising capital, sourcing talent, and pursuing social impact. ‘Frontier’ markets are those outside of Silicon Valley, Boston and New York City. Indeed, frontier start-ups (camels and cockroaches) may have greater insight into cultural context, with social missions personalized to the frontline needs of diverse peoples and settings with real experience in mental health problems. Emerging markets, such as those in Africa and Southeast Asia, often encounter problems with not only capital, but a lack of infrastructure and regulation. To operate in such markets, the philosophical dedication Silicon Valley adheres to in growth and scaling at all cost is not feasible.
These emerging frontier innovation ecosystems provide multi-regional and multi-contextual lessons to startups outside the Silicon Valley model, including the need to build risk mitigation into the culture of the organization, as well as into key performance indicators. There is great value of these company models in mental health innovation, as the formidable global burden highlighted and amplified by COVID-19 calls for support to not only those companies that disrupt existing ecosystems, but those that create and adapt to new ecosystems in contexts of high need and low competition.
The Critical Need for Gorillas to Invest in Mental Health Tech
Large corporations aka ‘gorillas’, with their significant human and financial resources, are clearly key to advancing the mental health field. These corporations may be varied, from tech companies, to social media companies, to pharmaceutical companies and beyond. There are several key examples of responsible action by large corporations in recent years. An exemplar for product risk mitigation comes from Pinterest, a social media and app company with around 335 million users. Pinterest is a platform that allows people to discover new information and save this information on their virtual “pinboards”. Pinterest combines social media, by allowing users to share and save different graphics or “pins” they find on the platform, with marketing, leading to superb social engagement. Users can personalize their pinboards not just by the items they “pin”, but also by coordinating different pinboards with different themes. One of the factors that makes Pinterest unique is that it appeals to users of all ages and different demographics, given how easily accessible the “pinned” items are to find on the Internet. However, there can be adverse effects to having such an accessible platform, using items found primarily on the Internet. One example is how users can begin utilizing Pinterest as an outlet for their more challenging emotions, such as depression, stress, anxiety or frustration. Although this type of social engagement can lead to a virtual community building, it can also lead to propagating these difficult emotions and not providing sufficient and necessary treatment or therapy. Pinterest approached this problem by introducing evidence-based cognitive behavioural practices on its platform, specifically for users whose search patterns and themes on their pinboards were concerning for untreated distressing emotional states. This is an excellent example of a responsible innovation strategy. By maintaining privacy, but still identifying potential problems users may be facing. Privacy was maintained by not linking users’ interactions with resources related to difficult emotions to their accounts. In addition, records of activity were stored anonymously using a different, third-party service, unrelated to the Pinterest platform. Pinterest stands out by providing its users a novel, safe and caring place to be a part of.
Johnson & Johnson (J&J), a large diversified medical innovation company spanning digital, pharmaceutical, device and consumer solutions, recently announced a new endeavor called Science for Minds. Science for Minds was created to bring together an inclusive and open research culture, focusing on the pillars of science, innovation, and society. Science for Minds will engage in digital solution development, novel diagnostics, novel targets, novel investment approaches and stigma reduction. Husseini Manji MD, was named as head of this new endeavor, which follows his eight-year tenure as Global Therapeutic Head for Neuroscience at Janssen Research & Development (a J&J company).
Finally, Google’s X Lab recently announced Project Amber. This project focused on three areas: making EEG data easier to collect, making EEG data easier to interpret, and understanding how this technology could be applied for patients. These three areas act as steps toward Project Amber’s ultimate goal: find a biomarker for depression and anxiety. Project Amber uses common and everyday technologies and materials, such as a swim cap and dry sensors, to make the product more accessible for people of all socioeconomic statuses and demographics. Further, cutting-edge machine learning techniques are combined with the EEG to bring new clinical possibilities to this 96-year-old technology. Project Amber provides an opportunity to combine subjective and objective mental health data and has a myriad of potential use cases, such as providing ongoing monitoring. This technology may be especially impactful in predicting depression symptoms, monitoring treatment response, and being used in-conjunction with digital phenotyping. While this development is exciting, depression and other mental illnesses are incredibly complex and intertwine genetics and social factors and finding a single biomarker for depression is unlikely at this time. However, as data continues to be gathered and analyzed, technologies like Project Amber will undoubtedly continue to be relevant for clinicians and the layperson.
Unique Leadership is Required
Nurturing the mental health tech menagerie will require a unique leadership approach, which current structures are not tailored to provide. Indeed, this menagerie is likely to be driven by private markets; hence, stewardship by various entities is critical. Innovative entities supporting leadership and policy in this area include the World Economic Forum’s Global Future Council for Neurotechnologies and Brain Science, which explores the strengths and limitations of artificial intelligence in mental health care, and the Asia-Pacific Economic Cooperation Digital Hub for Mental Health, which works to share, develop, scale up, and evaluate innovative evidence-based and practice-based programmes for mental health support. We also note the Mental Health Innovation Network which aims to facilitate the development and update of effective mental health interventions by enabling learning, building partnerships, synthesizing and disseminating knowledge, and leveraging resources.
A New Workforce to Nurture this Menagerie
A new type of workforce becomes essential to nurturing our abovementioned mental health tech menagerie; the field of Mental Health Innovation Diplomacy is suited for this. Innovation diplomacy includes helping to build academic partnerships with industry, enabling open innovation and collaboration, influencing intellectual property regimes, building global value chains, and developing and scaling innovative solutions to global problems. To this end, we articulated a model of mental health innovation diplomacy which aims to strengthen the positive role of novel technological solutions and recognize and work to manage both the real and potential risks of using digital platforms. This initiative recognizes that technological innovations relating to mental health can have political, ethical, cultural, and economic influences. Adapted from the Nesta (formerly NESTA, National Endowment for Science, Technology and the Arts) Innovation Policy Toolkit, we elucidated roles relevant to mental health innovation diplomats — see table 2. Entities supporting mental health workforce development include the Global Brain Health Institute with the Atlantic Fellows for Equity in Brain Health programme.
Table 2: Roles Relevant to Mental Health Innovation Diplomacy Practitioners
We recently noted the critical importance of operations and governance in this field, to ensure successful execution and investor confidence. Our field focuses almost exclusively on the power of the technology. Without solid operational effectiveness and governance, we all stand to see the momentum for our field (and hope) evaporate if investment dollars (of any kind) dry up. This would be a disaster as we need sustained, multi-decade engagement in the area. Reminder: The burden of these disorders is projected to increase to around USD $16 trillion per year in lost economic productivity by 2030.
Given that technology has encroached into the clinical space as one of the most important avenues to address the mental health burden, it is essential to create structures and environments that allow these diverse corporate and public entities to deliver the necessary benefits to population mental health. An ecosystem of diverse corporate beasts is likely to be needed as well as new structures for coordination to aid diverse goals from strategic development, embedment into routine care, risk management and sustainability.
Diab Ali, Senior Medical Student and President of the Gold Humanism Honor Society, Ochsner Health System, New Orleans, Louisiana, USA
Michael Berk MD PhD, Professor of Psychiatry and Neuroscience, Deakin University, the University of Melbourne, ORYGEN, The Florey Institute for Neuroscience, Melbourne, Victoria, Australia
Rashi Ojha, Associate with PRODEO and The PRODEO Institute, Senior Medical Student at UCLA
Erin Smith, Associate with PRODEO and The PRODEO Institute, Founder of FacePrint
Harris Eyre MD PhD, Co-Founder of The PRODEO Institute, President and Chief Medical Officer of PRODEO, Adjunct Associate Professor, Deakin University, San Francisco, California, USA