By Rachel Lee, California Health Care Foundation, September 20, 2019
In California, nearly two out of three adults with a mental illness do not receive mental health services, and only 1 out of 10 adults with a substance use disorder receives any kind of treatment. These gaps in care have drawn the attention not only of policymakers, but also health technology investors and entrepreneurs. Last year, health tech start-ups, including Quartet Health, Lyra Health, and Pear Therapeutics, raised nearly $400 million in funding for technology investments related to behavioral health. Investors have included leading venture firms like Venrock and Greylock Partners, as well as national private payers such as Centene and Anthem.
Although research supports the efficacy of some smartphone technology–enabled behavioral health interventions in controlled settings, widespread adoption has been slow, particularly among providers and payers in the safety net. As Thomas Insel — California governor Gavin Newsom’s designated state “mental health czar” — recently said, “As much as one might hope there’d be an app for that — it’s really complicated.” Insel has dedicated a significant portion of his career to technology-driven behavioral health projects, including a stint at Google life sciences subsidiary Verily, and as cofounder of the start-up Mindstrong, with which he is still involved. Recent pilots have demonstrated evidence of a variety of significant barriers, with neither entrepreneurs nor participating providers and patients seeing much meaningful improvement in access or quality.
Last year, when mental health providers in Los Angeles County tested a smartphone app to help patients manage emotional distress, they encountered major setbacks, such as concerns about low patient engagement and compliance with patient privacy regulations. In 2015, low participation levels were reported in similar pilots testing computerized cognitive behavioral therapy in California’s safety net. Other behavioral health start-ups have been stymied in California by a complex behavioral health care system with fragmented funding streams and a daunting array of stakeholders that includes counties, Medi-Cal managed care plans, and public hospitals.
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