What future for Mental Health?
Since the beginning of the global pandemic in 2020, two previously taboo words have entered the collective language: mental health. By containing travel and interactions, the pandemic has affected the mental health of a large number of individuals.
It is one of the many contemporary factors that, according to the WHO, creates psychological disorders in one out of five people in the world. A long-neglected disease that can now be diagnosed and accompanied thanks to digital.
To understand what mental health is, the ecosystem of innovative companies that already address solutions, and the challenges ahead, we spoke with Dr. Fanny Jacq, psychiatrist, director of mental health at Qare, member of Future4care, and president of the MentalTech collective. She shares with us her vision and some thoughts on the future.
Psychiatry has long been the poor relation of medical innovation
Mental health, according to the definition given by the World Health Organization (WHO), is "a state of complete physical, mental and social well-being... in which a person is able to fulfill his or her potential, to cope with the normal stresses of life, to do productive work and to contribute to the life of his community. This broad and positive definition makes it clear that mental health is not simply the absence of mental disorder or illness, but is an essential component of an individual's overall health. In other words, there is no health without mental health.
However, until now, mental health was essentially associated with psychological disorders and psychiatric pathologies, which include schizophrenia and other acute or chronic psychotic disorders, bipolar disorders, post-traumatic stress states, eating disorders, anxiety disorders, phobias, depression, burn-out, addictions (to screens, tobacco, alcohol, drugs), OCD, autistic disorders, but also personality disorders that can evolve into pathologies (borderline personality for example). The manifestation of these disorders causes very heterogeneous clinical situations, with more or less disabling or chronic affections depending on the person. In France, an estimated 12 million people are directly affected by at least one of these pathologies, i.e. nearly one individual in five.
These so-called mental illnesses have long been (and still are) stigmatized. At the beginning of the 19th century, the "asylums" as they were called, were built outside the cities. They had orchards, vegetable gardens, animals... in order to be self-sufficient and to allow people from the city not to meet the sick.
Today the asylums have been renamed "specialized hospital centers" (CHS) but specialized in what? We are not told, and the word CHS is still taboo in psychiatry.
Moreover, psychiatry has long been the poor relation of medical innovation. In fact, psychiatric care has remained more or less the same for the last 70 years. Most of the time, it consists of a search for symptoms during an interview, the filling out of questionnaires by the patient, the diagnosis by the practitioner and the start of a treatment: medication and/or psychotherapy.
But with appointments spaced several weeks apart (in the best of cases), and without knowing anything about the patient's life or environment outside the office consultations, it is very difficult to develop a continuous and personalized follow-up.
This is why digital technologies, such as the real-time collection of patient data, are likely to revolutionize the support of mental pathologies, their prevention and their destigmatization.
Especially since mental health is a spectrum and not a binary phenomenon. People with mental disorders can experience good mental health. And conversely, it is possible to have poor mental health without having a mental illness. For this reason, mental health is often referred to as a continuum, which can vary over the life course as a result of a number of socio-economic, biological and environmental determinants.
We are facing one of the major economic and societal challenges of the century
Mental illnesses are the leading cause of health insurance expenditures. Each year, it spends more than 23 billion euros on them, which is more than the resources allocated to cancer (18 billion euros) and cardiovascular diseases (13.4 billion euros).
A study conducted a few months ago by the Sapiens Institute for the MentalTech collective showed that the development of digital innovations in the field of mental health would lead to a reduction in logistical costs (transport, hospitalizations) and consultation costs, as well as an increase in the number of patients followed up, an improvement in follow-up, care and compliance, and a reduction in the use of psychotropic drugs. The combination of these effects could lead to a significant reduction in expenditure, generating 5.9 billion euros per year in direct savings and 9.4 billion euros per year in indirect savings - a total gain of 15.3 billion euros. Not to mention the improved mental well-being of patients, earlier detection of disorders, and more personalized, rapid and effective management of disorders that could be achieved through the introduction of e-mental health technologies.
Yet it took until the second half of the 2010s for digital innovation in mental health to emerge, like the mobile apps Petit BamBou (2014), Kwit (2017), or Mon Sherpa (2019). This slowness can be explained by a structural phenomenon, linked to the health sector itself, marked by regulatory, legal, approval, accreditation and data security constraints. As a result, health care is generally the last to innovate, and mental health even more so, because of the obstacles and taboos mentioned above.
In the end, it’s to the health crisis that we "owe" the increase in the use of various e-mental health tools. Because if the Covid-19 pandemic has strongly degraded the psychological health of individuals all over the world, it has also created new uses among patients. They have taken greater advantage of the tools offered by digital technology, starting with teleconsultation. As a result, by 2021 more than 120 e-mental health startups were created worldwide, and venture capitalists poured a record $5.5 billion into mental health and wellness specialists, a 139% jump from $2.3 billion in 2020.
Now that there are more and more e-mental health solutions, several classifications are possible.
By level of technology: solutions that are easy to access, easily reproducible and diffusible among users, alongside "hard tech" technological solutions that are more complex and demanding in terms of investment and engineering.
By type of audience: while some solutions are aimed at mental health professionals and others at caregivers, the vast majority are aimed at patients, who can themselves be divided into sub-categories: children and adolescents, adults, seniors - for example.
But the most relevant classification remains the placement of the solutions on the care pathway, from prevention to cure. Upstream of the care pathway are primary, secondary or tertiary prevention solutions, as well as mental well-being or behavioral health solutions. Continuing the journey towards more curative functions, the solutions provide diagnostic assistance, connect patients with a professional... up to devices that allow the treatment of identified pathologies.
The business model of these mental health startups also differs. We can already identify 5 ways of financing ourselves when we address a mental health issue.
Non-medical solutions called "wellness", like Petit BamBou, are self-financed and/or financed by private funds, and often operate according to the "freemium" model: part of the functionalities are accessible for free, and the complete solution is offered as a paid subscription (even if other sources of income are possible, such as advertising revenues or monetization of databases for example).
Other solutions, such as Mon Sherpa, a chatbot for people suffering from mental illness, are free. In this case, the free solution sometimes acts as a "call product" for services that may have to be paid for, such as chat with a therapist or teleconsultation with a health professional.
Corporate mental health solutions, such as mindDay, Lumm, Holivia or moka.care, are based on a BtoB model. The final payer is the company that offers these services to its employees.
Medical solutions for patients, such as HypnoVR or ResilEyes Therapeutics, fall under the regulations for digital medical devices. They must prove their clinical effectiveness (and therefore the service rendered) to obtain the CE mark and submit a file to the Cnedimts to apply for reimbursement, the evaluation focusing on two aspects: health (in the clinical sense) and medico-economic contribution. For the moment in France, no digital medical device for mental health seems to have passed these two stages, but the process is underway and it is only a matter of time. The market for digital therapies is booming, and the news that a plan for digital mental health is being prepared for the fall is very positive.
Another model that is developing rapidly is that of partnerships with mutual insurance companies or health insurance companies. In this case, the mutual insurance company offers its members a health solution in addition to the usual services. By broadening and diversifying its range of services, it develops an innovative approach that allows it to stand out from the competition.
The issue of well-being in the workplace is becoming essential
If more and more solutions are aimed directly at companies, it is because the cost of ill-being at work borne by them is very high, around €13,340 per employee per year, mainly caused by absenteeism and the related drop in productivity.
One third of the French population is affected by stress at work. A study conducted among general practitioners has shown that when they are consulted for reasons of anxiety or stress, work is the main cause.
New work organizations and the era of permanent connection are generating new psycho-social risks. The permanent state of alert in which working people find themselves weighs heavily on their mental health. The boundary between professional and personal life is no longer so clear (we speak of "blurring"), and not everyone has the necessary resources to deal with it.
Issues of well-being at work or quality of life at work (QWL) emerged in France in the 2000s. But here again, it seems that it is the health crisis that has moved the lines: recently, the term "mental health" has entered the lexical field of the company.
A PSYCHODON & OPINIONWAY survey released in April 2021 indicates that 76% of employees believe that the company is responsible for the mental health of its employees, but that only 31% of companies put in place resources to promote well-being.
The range of solutions available to companies wishing to address the mental wellbeing of their employees is vast, from simple awareness-raising initiatives to employer-supported telemedicine solutions - and they can be combined to multiply their effects.
Since there are still many taboos and prejudices surrounding mental health, information and training are useful in deconstructing and changing representations. Many organizations, both private and associative, offer webinars, workshops and other awareness-raising conferences in companies. To go further, a two-day Mental Health First Aid course, delivered by PSSM France, allows for the training of mental health first aiders.
Self-help solutions provide first-level assistance, accessible 24/7: through a website, a mobile app or a chatbot for example. The most elaborate of these tools are based on the principles of cognitive psychology or behavioral health, and allow the user to find support for mild symptoms, or as a complement to therapy. Examples include Alan Mind or My Sherpa, the psychological support solution from Qare.
Solutions for connecting with psychologists, coaches, and other therapists have multiplied since the health crisis. If the process of consulting is a personal initiative, the company can nevertheless facilitate it by removing the obstacles, particularly economic ones, to treatment.
Finally, for consultations with a psychiatrist, only telemedicine companies are authorized to offer teleconsultation. Qare, for example, offers a complete health program combining prevention, access to care 7 days a week in about fifty medical specialties, and medical follow-up.
It should be noted that all these steps require a more or less engaging personal approach on the part of the employee who will learn to take care of himself and ask for help if necessary. However, the role of the company at the collective level should not be minimized. It is up to the company to set up a healthy and efficient work organization that allows for a fair balance between professional and personal life.
If the players involved sometimes pass the buck, it is because the malaise that is expressed at work is multifactorial. In the case of burnout, for example, it is commonly accepted that 60% of its origin is organizational (i.e. attributable to the company), and 40% personal. Although evolution is slow, it must be admitted that undeniable progress has been made on the employer's side. There is a growing awareness that emergency numbers are no longer enough and that it is necessary to act upstream to educate and prevent. Some companies are taking up the subject with great sincerity and commitment as part of their CSR approach, while others have only a reactive and short-term vision akin to "mental washing".
It is time to accelerate the development of this ecosystem
A first step has been taken, words have been spoken, actions have been undertaken, such as the Mental Health Conference organized in 2021. And this deserves to be emphasized. But it is still not enough. According to the WHO, depression will be the number one disease in the world by 2030, and mental illnesses are the ones that cost the most to the Social Security. The measures and budgets allocated are therefore not yet up to the task.
As for the financing of companies that innovate for our mental health, the majority of operations (68%) in 2021 were carried out in startups in the seed phase, which demonstrates the lack of maturity of the market.
In France, with the exception of Alan (€183M), the fundraising of players operating in the field of mental health remains modest, such as moka.care (€15M) or HypnoVR (€4.5M). But the financial survival of start-ups depends on it. For those who decide to become medical devices, and even more so to become reimbursable, it can take several years before they are ready to be marketed - years during which they will have to undertake costly clinical investigations, certification and medico-economic studies.
Although the French e-mental health ecosystem is very dynamic, with more than sixty players listed, it remains highly specialized, fragmented, immature and therefore potentially fragile. As shown in a study by the Sapiens Institute entitled "Building the Europe of e-health - Emerging European health champions to resist foreign Big Tech" published in February 2022, the main challenge for the e-health market lies in reaching a certain critical size. Regulatory facilitation is the key. Without it, there can be no European health data policy, no common development policy, and no innovation incubation structures. Yet this favorable soil is essential for the emergence and development of start-ups to enable them to reach the necessary maturity.
If things are not moving fast enough, the younger generations are very mobilized. They are hearing more and more about the importance of a good mind/body balance and the notion of mental health. In fact, the subject has become less taboo and the word is getting out - notably under the impetus of social network accounts, artists like Stromae, or athletes like Simone Biles or Naomi Osaka. All of them now dare to talk about mental health in an unfiltered way. Ideally, the subject should be brought up in school, starting in childhood. Just as we teach sex education or civics, it is important to teach our children - the adults of tomorrow - that there is no shame in expressing our emotions, our fears, our fragilities, and in asking for help if necessary. It's OK not to be OK!
Are you a mental health startup at an intermediate stage of development? Write us to accelerate your go-to-market.
Thanks again to Dr. Fanny Jacq, for her valuable insight.
About the MentalTech collective
The MentalTech collective is the first French collective dedicated to the emergence and development of digital solutions in mental health. It was created in March 2022 by 7 founding members: hypnoVR, Kwit, mindDay, PetitBamBou, Qare, ResilEyes Therapeutics, and Tricky.
Its purpose is to bring together private and public organizations around a strong ambition: to respond to the urgent need to deploy ethical digital tools in the prevention and management of mental health, alongside healthcare professionals.