Why Digital Mental Health is Like the Wild West

Why Digital Mental Health is Like the Wild West

When I talk to people about the digital health space – specifically digital mental health – I often say, “It’s the Wild West!” and everyone nods. But then I stopped to think about what I really mean by the Wild West. I realize that the metaphor holds up very well.

wild west

There is a gold rush. The California Gold Rush began on January 24, 1848. News of the gold brought some 300,000 people to California from around the world. They were called forty-niners in reference to the year the fever really hit, 1949. Tens of billions of today’s dollars in gold was recovered. The gold rush transformed the economy of California and economies all over the world.

The financial opportunity – and temptation – represented by the digital mental health revolution is similarly profound. Americans alone spend over $148 billion annually on mental and emotional health. Moreover, more than half of people suffering from emotional and mental distress will never seek treatment – meaning there is a huge, unmet need. Of these who don’t seek treatment, over 45% cite price as a barrier, and over 40% cite stigma as a barrier. Digital health tools, like mental health apps, address these barriers by being highly accessible and highly affordable. They also have the potential to neutralize stigma because, as I’ve argued before, mobile devices are the hub of our lives and thus what we do on them automatically gains an aura of “good.”  Digital health therefore represents a perfect marriage between social good and economic potential, and there are plenty of forty-niners who see this opportunity and want to cash in.

There are snake oil salesmen. Indeed, many companies are jumping on the wagon and digging for digital health gold (to keep the Wild West metaphor going). Some of these companies offer great, beneficial products, but others are “snake oil salesman.” Snake oil is an old-fashioned term that tends to refer to fraudulent health products or unproven medicine, but in general refers to any product of questionable quality. A snake oil salesman is someone who knowingly sells these fraudulent products. You see these guys as comic relief in Western movies all the time, usually a traveling “doctor” selling fake medicines, who leaves town before customers realize they have been cheated.

One way for us to get around the risk of snake oil is to elevate the dialog around digital health and develop ways of evaluating the scientific quality of what’s out there, since none of this is regulated (yet). This will help us look past the shiny bottles of alluring medicines that are actually snake oil, and find the real healing agents. Psyberguide is one organization I came across that appears to be trying to do just that.  If we don’t push ourselves as an industry to meet standards, we risk becoming comic relief rather than a true paradigm shift. We also risk repeating the failures of the analog healthcare system, just making them digital.

There are pioneers.  I believe that a science-backed digital health revolution will be the single most important paradigm shift in the failing mental health industry. This revolution will allow people to promote their personal wellness like they do their physical wellness and fitness. It will allow people to access treatments that are effective without being too expensive, burdensome, or stigmatizing. We need to think outside of the box for a true paradigm shift to occur in how people access support for their emotional and mental health – whether that’s the transformation of how patients access their health information through electronic medical records, how health information is collated to lead to better diagnosis and treatment, how health information is gathered through tests done on mobile devices, or how interventions are accessed, through mobile health apps and digital brain training. Pioneers in digital health are rethinking how to empower the individual to promote their own mental and emotional wellness, to use personal health information to actually improve our lives, not just be monetized by big companies mining our big data.

I firmly believe that destigmatizing mental illness and emotional distress will be the linchpin in this paradigm shift. Mental health – when we say those words, we think illness, not health. We think of people being crazy, despondent.  Why is that? It is because Psychology and Psychiatry have failed to make mental health a positive goal like physical health and fitness. When we struggle emotionally, we feel broken. Treatments are burdensome, hard to access, and stigmatizing. We need to be on the vanguard of a paradigm shift away from stigmatizing, expensive treatments emerging from the “if we build it they will come” mentality, and towards a new vision in which people are empowered to personalize their mental wellness through tools that work for them, when and where they want them.

If pioneers brave the Wild West that is the digital health field of 2015, we have a chance of creating something that transcends our humble beginnings to actually make a difference.

9 thoughts on “Why Digital Mental Health is Like the Wild West

    1. Ha! A small mercy. That does make me think of other Wild West characters that could continue the metaphor – the good but overwhelmed sherif, the fallen woman with a heart of gold, the tough old matriarch of the town called “Ma” something or other…. 🙂

  1. I see a Western culture that is tech-obsessed coupled with an unhealthy relationship to said tech. What do you think about addressing technology use before it becomes an issue of digital mental health?

    1. I agree that digital technology has the potential to be both the solution and the problem. I think with many technologies, this is the case. It is up to us to use any technology as a tool that promotes well-being. Not as easy as it sounds! Thank you for your comment.

      1. “Mental health – when we say those words, we think illness, not health. We think of people being crazy, despondent. Why is that? It is because Psychology and Psychiatry have failed to make mental health a positive goal like physical health and fitness. ”

        You hit the nail on the head. This is so true! The words mental health bring to mind a depressed person struggling to pinpoint and fix the problem. But physical fitness? I instantly picture a strong-willed young woman jogging in bright shorts and sneakers — the colors of energy, health, and exuberance — nearing her goal.

        I think these associations are a result of how mental health and physical health have been portrayed in the popular media over the years. How many magazines, celebrities, blogs, and trainers have linked physical fitness to health, confidence, and sex appeal? Those three are the motivating factors that have been highlighted first to inspire the consumer, and once users feel energized for change, they are ready to engage and pursue the process. Now how many magazines, celebs, blogs, and practitioners have made mental health “sexy”? How many have linked it to health, confidence, and sex appeal? None I can think of. Instead, the focus has been on featuring a person with a problem and then fixing a problem. Boring. Not inspiring or fun.

        I think one solution is for mental health to borrow the tools physical health has used for ages to de-stigmatize mental health and make it more accessible. What if popular campaigns focused on showing you the positive outcomes first of taking care of your mental health, starting with the end in mind instead of the beginning? What if blogs and health sites started goal-oriented challenges around confidence and assertiveness and emotional stability, as the gifts of evidence-based mental fitness interventions that are accessible, structured, and easy to do? (This is where creative mental health apps that work come into play.) What if magazines, websites, and blogs profiled people who did just that, and celebrities endorsed apps like the one you made? And what if practitioners themselves a) used social media and blogs to focus on the wonderful results of therapeutic interventions, and b) used apps to complement their therapy and make what you learn easier to access and to stick?

        Technology presents a huge and exciting opportunity for progress, for giving mental health the “facelift” it needs. And with the Internet and social media having democratized the flow of information, I think now we are closer to it than ever.

        The other thing is options. With physical fitness, you have SO many options and concrete tools: You can run, swim, dance your way to the goal. You can work out solo or do team sports and summer leagues that end with fun outings that build community. You can download apps to track everything from steps to calories. I used to work at a health company that gave us fitbits in the summer, split us up into teams, and had us compete to reach 10,000 steps a day, and so physical fitness became a social challenge with those you know. With mental health there are few choices and each has its limitations: therapy with its barriers that you mentioned, self-help books not based on science, books written by trained researchers and psychologists that are good to read yet hard to remember and to apply, and the slew of apps you mentioned, many of which have no evidence base. One solution I think is for digital mental health interventions to piggyback on the success of physical health apps … instead of separating physical and mental health apps, there can be a mental health component alongside the physical health part of an “overall health” app. Another is to get creative and make apps fun and game-like, as you’ve written, and I also look forward to seeing people add a social component to these types of apps, because the social apps are some of the most addictive ones out there.

        By the way I love the term “mental fitness” … or even mental wellness … they both take away all the negativity that has been associated with mental illness. And in general, you’ve written a wonderful blog … so much food for thought here. Thank your for writing!

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