Mental Health Tech and Covid-19 – The Coming Wave

The Covid-19 crisis will generate a wave of mental health challenges that will require innovation and technological breakthroughs. Mental health is a critical part of our collective Covid-19 recovery. It’s also important to effectively navigating the ups and downs of personal and professional life. The good news is that there are many technology-enabled tools available today to track and improve our mental health. We reviewed the state of play in mental health technology and its applications to the Covid-19 recovery.

Mental Health During Covid-19

This pandemic has touched nearly the entire planet. Over a third of the world’s population has been asked to stay at home in order to limit the spread of Covid-19. In the US, 3 out of 4 Americans are in some form of lockdown. It is a shared experience that has forced many people to significantly alter their way of life.

You may be one of the many required to shelter-in-place for an extended period of time. Or you may be on the front lines dealing with patients in a hands-on way (thank you!).

You may also be worried about the impact to your employment, to loved ones, or just stressed about what the new normal might look like.

In response to all this uncertainty there is an emerging consensus that a wave of Covid-19-related mental health challenges are on the horizon.

Whether they come from extended isolation, loneliness, stress, anxiety or trauma. There is an understanding in the scientific community that something similar to post traumatic stress disorders (PTSD) is expected in large numbers and across the population at large.

Writing articles like this, where technology and society meet, are some of my favorite topics. It’s here where I am able to apply my scientific training in biomedical technology to hopefully make a difference for someone.

Let’s start by looking at what the experts and leading organizations are saying.

What the Experts are Saying

Word Health Organization (WHO)

According to the World Health Organization “managing your mental health and psychosocial well-being during this time is as important as managing your physical health”. This is from a recent publication by that organization entitled Mental health and psychosocial considerations during the COVID-19 outbreak (March 18 2020).

The WHO also recommends gathering information at regular intervals on local health authority platforms in order to help you distinguish facts from rumours. Facts can help to minimize fears and reduce uncertainty.

CDC

The CDC is recommending video visits and consults to help avoid exposure and reduce the risk of being exposed to germs in the waiting room. They also published a fact sheet to help people identify the signs of stress and provide useful general guidance on Mental Health and coping with stress. The symptoms below are associated with deterioration in your mental health:

Common Signs of Distress
Feelings of shock, numbness, or disbelief
Change in energy or activity levels
Difficulty concentrating
Changes in appetite
Sleeping problems or nightmares
Feeling anxious, fearful, or angry
Headaches, body pain, or skin rashes
Chronic health problems get worse
Increased use of alcohol, tobacco, or other drugs

FDA /SAMHSA

In April 2020 the FDA has relaxed rules in order to more rapidly deploy possibly beneficial Computerized Behavioral Therapy (CBT) and digital health therapeutic devices for psychiatric disorders.

The guidance allows low-risk general wellness and digital health products for mental health for psychiatric conditions to be available to the broader public.

Several companies have already leveraged this guidance to make available certain apps and computer based therapies. Some of these efforts are highlighted in the next section of this article.

The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes a list of resources and information useful for caregivers, researchers and individuals. The SAMHSA resources are worth a read for especially those with pre-existing psychiatric or neurological disorders.

Emerging Scientific Research

A leading research team from the Department of Psychological Medicine at King’s College London published a review of the psychological impact of quarantine (Lancet March 2020).

They find “the evidence that a psychological effect of quarantine can still be detected months or years later… is more troubling…”.

During the SARS & H1N1 spread they found that “the effect of being quarantined was a predictor of post-traumatic stress symptoms in hospital employees even 3 years later”

Qualitative studies of people under quarantine also identified a range of other psychological responses to quarantine such as confusion, fear, anger, grief, numbness and anxiety-induced insomnia.

Other research (also recently published in The Lancet) entitled Timely Mental Health Care for the 2019 Novel Coronavirus Outbreak is Urgently Needed found that “Based on experience from past serious novel pneumonia outbreaks… mental health assessment, support, treatment and services are crucial and pressing goals for the health response to the 2019-nCoV outbreak”

Putting it all together

Finding credible resources and understanding what the scientific consensus is telling us is important. Mental health is clearly emerging as a factor that will affect people right now and in the coming months and years.

Health systems, world bodies, governmental agencies and the scientific community are largely in agreement on the impact covid-19 and quarantine will have on our society.

Much of this expertise was gained from prior experience in dealing with the spread of infectious disease (SARS, N1H1, Ebola). While previous cases have been largely isolated to specific regions of the world, Covid-19 is unique in its spread globally.

What this means for you

So what does this mean for you? It means that right now we should all be thinking actively about our mental health. How do we recognize signs and symptoms and what resources are available to us.

Lastly, how can we empower ourselves and be proactive about our mental well-being? There are many actions we can be taking today. Luckily, there is no shortage of options and in fact there are more being created everyday. The pace of change in the mental health space is increasing rapidly. Technology is playing an ever increasing role here.

Next, we’ll outline some of the technology trends emerging in the mental health space today.

Tech in Mental Health

Software and Apps

In mood tracking and depression alone there are over 240,000 app user reviews across 75+ available apps. Many already have specific help for Covid-19 specific issues.

These generally fall under categories such as Medical, Health and Fitness, Lifestyle and Productivity.

Many of the common features include

Mood ranking and tracking
Journaling with categorized entries
Educational guidance based on Cognitive Behavioral Therapy and other methods
Help identify thinking traps and patterns
Visualizations and charts to track progress
Connections to a community, counselors, doctors or therapists

Some of the most highly reviewed options include:

Devices and TeleHealth

One in five Americans has a smartwatch or activity tracker like a Fitbit, which typically returns better quality data than a smartphone presently can. Dedicated wearable technology devices are also being developed specifically for mental health care. Here are a few examples available now or on the horizon:

Empatica is now providing their Embrace 2 wristband for seizure detection to customers in the US without immediately requiring a prescription from a healthcare provider. In other words, you can receive your Embrace as soon as you order it from their online store. Don’t forget that you will also still have 30 days of free trial to see if Embrace and Alert are right for you.

Psious provides VR therapy software for psychology and mental health. They target at least 20 different disorders including PTSD, Stress, social anxiety, generalized anxiety and OCD.

The PIP device which measures skin conductance is a small device you can carry to record a stress measurement. Along with its app you can record and visual historical stress history.

Launched in 2015, the Spire Stone is one of our favourite stress tracking products because it’s all about calming your breathing. The Stone can identify stressed and calm breathing patterns, then offers guided breathing exercises to get you back to neutral. Since then, Spire has also brought us the Spire Health Tag, which offers similar insights to the Stone, but can be ‘tagged’ to your clothes.

Over the past few weeks, they have been discussing with pulmonary physicians the use of the spire technology as an adjunct to both traditional and novel approaches to manage patients during the COVID-19 crisis. Three key use cases have emerged from these discussions:

As a tool for reducing infection. For those at high risk of serious complications, such as COPD patients, RPM helps avoid the need for visits to practices, clinics or ERs.
Reducing time spent in high-risk environments. For patients in the early stages of infection or those recovering post-discharge, respiratory monitoring is a critical parameter to gauge health status.
Facilitating earlier intervention. RPM may help detect the early signs of symptoms related to COVID-19, such as elevated respiratory rate and allow automatic notification to the patient’s care team.

Spire’s remote monitoring platform can be deployed rapidly with equipment mailed directly to patients without any interaction required and we also have a nationwide team of respiratory therapists on hand to assist with first line patient monitoring.

Touchpoints has developed a tactile bilateral alternating stimulation system, (formerly Buzzies), a pair of wireless devices worn on wrists or in pockets when a patient feels anxious. This technology aims to “change the brain’s response to stress to a great degree”.

Digital Therapeutics

These are prescription-based software therapies intended for treatment of disease. While it can sound like science-fiction, there are several companies actively pursuing products in this area.

Pear Therapeutics is perhaps the most well known startup in this area. They have three products so far, the PearConnect Platform, reSET for treatment of addiction and Somryst for treatment of insomnia.

Based on the recent FDA guidance to increase access to digital health devices for treating psychiatric disorders, Pear recently announced the launching of a limited distribution program for its Pear-004 product candidate.

Pear intends to collaborate with select healthcare providers and academic centers to provide patients with schizophrenia and schizoaffective disorder access to Pear-004 for use in combination with atypical antipsychotic medications.

The Future of Tech in Mental Health

It has become clear that there is a looming mental health crisis in the US. Mental health awareness and its impact on overall wellness was already on the rise. Employers and health care professionals alike were well on their way to making this a focus and priority.

If there is any positive impact from the coronavirus it is that it has placed issues like mental health front and center. It has brought mental health to light and made all of us acutely aware of the importance of this issue in our daily lives.

For those companies already innovating in this space, there is a golden opportunity to have an immediate impact with their products and solutions. It has paved the way for others to enter this space with innovative solutions.

If stress is a big problem for you, it could be worth investing in a device that puts tracking your stress, and helping you to keep calm, front and centre, such as the Spire Stone.

For everyone else, your best bet is to pick a fitness tracker that offers the kind of stress and calming features that best suit you. For example, the Fitbit smartwatches and Apple Watch are great for breathing exercises, whereas something like Garmin’s heart rate tracking makes its stress monitoring features easily accessible.

We expect these stress-tracking and mindfulness features to be even better once tech companies start doing more useful things with the data, such as recommending tailored breathing exercises when you seem stressed, or turning on a continuous stress tracking feature if you haven’t had enough sleep and might be prone to feeling agitated throughout the day.

The future of technology in mental health is bright. We are only witnessing the beginning of this transformation. One thing is quite certain – mental health treatment will be the next proving ground for a connected and metrics based healthcare model.

Final Thoughts

Our remote work situations have highlighted how enabling technology can be. This recognition is already part of the telemedicine transition that we are living through right now. Mental health will be no different.

In fact this may be the next proving ground for the coming wave of medical technology. With the pandemic fresh in the collective psyche there is a hunger for solutions that help us recover smarter.

There is also a sense that not everything will go back to how it was. We may work differently, companies may opt for smaller office footprints. If an at-home workforce becomes the norm, we will all want ways to convey to our employer and ourselves our ability to cope with these new conditions.

Access to resources such as telehealth and devices will be our way of quantifying, tracking and assessing how well we are connecting with colleagues, friends and family. How much is too much? And when is it OK to take that extra time or day off?

We’ll need the tools to not feel guilty about the way we feel. We’ll need the technology to empower us to talk freely about our mental health. Tracking our metrics and staying within health targets will be as ubiquitous as taking a blood pressure reading or watching our blood sugar.

We should all expect technology to continue to play a central role in our lives going forward. The mental health space will be no different and could very well be the next frontier of technology and medicine.