Digital therapeutics can close the employee engagement gap in mental healthcare

As a psychologist, I have provided both traditional face-to-face and virtual cognitive behavioral therapy (CBT) for patients while leading the implementation of digital mental health programs for a digital health company, Big Health. With an eye in both practices, my perspective spans the arc of where mental health therapy has been and where it is going. That stereoscopic view has been important when speaking with employers. Frequently, they’ve told me about their struggles to overcome the “engagement gap” that has frustrated their objective of delivering mental health intervention to more employees, a need that has soared during the past year’s crisis, as well as their uncertainty regarding outcomes for the people who are utilizing services. What I’m hearing is that employers believe there’s got to be a bigger, better EAP solution, but they aren’t sure how to go about choosing it.

Meeting the need: It’s about accessibility

The impact of COVID-19 on employee mental health has been severe, and benefits managers are all too aware of its effect on the workforce. Productivity is suffering as the stresses on disrupted lives have led to increases in absenteeism and presenteeism, and retention, too, has been adversely affected. The increase in mental health symptoms — anxiety, sleeplessness, eating disorders, drug use — has generated a greater awareness of the need for intervention, and the rise in prevalence has led employers to search how to engage more employees effectively and measurably. Even prior to the pandemic, 60% of people experiencing mental health symptoms did not receive care. The engagement gap — the deficit between a workforce’s mental health needs and therapeutic intervention — is costing companies more than what it would take to invest in solutions that would close the gap. A recently-published study I co-authored determined that digital CBT used to help people overcome insomnia resulted in a cost benefit of $681 per person over a six-month period compared to no intervention.

Read more:10 companies with the worst employee burnout

Accessibility to evidence-based CBT is the linchpin to addressing the mental health engagement gap. However, employers have a blind spot regarding choice. They believe that the gold standard is still face-to-face talk-based therapies. Certainly, traditional CBT helps many patients. But that’s not the issue here. Many people won’t or can’t access in-person therapy and prefer a more immediate and convenient therapeutic approach that isn’t restricted by incomes, schedule, geography or the stigma associated with an office visit. Half the counties in the country don’t even have a licensed mental health professional. Many employees don’t have schedule flexibility that permits workday appointments. Health plans limit the number of visits allowed for reimbursement. So, despite employers’ impulse to expand traditional talk therapy benefits, that won’t solve the accessibility problem. The systemic limitations won’t enable supply to meet demand.

Evidence in a new format

The explosion of telehealth during the pandemic has fundamentally changed how people seek and receive care. More than 40 million Americans used a virtual medical service in the past year. In-person talk therapy has migrated to telehealth to mitigate the restrictions imposed by COVID-19 but that still doesn’t increase the availability of treatment. In an effort to conquer the numbers problem, employers have begun to modernize their benefits offerings with technology-based, non-traditional mental health platforms, turning to digital therapeutics (DTx), excited by their accessibility and cost benefits. But they wonder: How do I decide which one to invest in? How do I measure outcomes? Will it close the mental health engagement gap in my company?

What you should know

As it is with in-person therapists, all DTx are not the same. Patients stick with therapists for all sorts of reasons, from the clinical to the logistical: I feel better after a session; my therapist listens to me; they enable me to see things in a new way; the time works for me; I like the magazines in the waiting room. The same is true for digital mental health solutions (except for the magazines). The clinical outcomes — recognition and resolution of problematic behaviors, development of CBT skills to better manage symptoms — are imperative and among the essential criteria for employer investment. Most therapists, in fact, do not measure outcomes. Conversely, the evidence-based attributes of CBT — structured intervention, frequent monitoring and measuring — are amenable to digital formats, which can in some ways more easily provide structural elements including measurement tools and real-time ‘homework’ support. It’s really the tools more than the talk that can make a difference.

To produce measurable outcomes, the delivery of the mental health solution has to work for patient preferences if the promise of scalable digital intervention can be realized and close a company’s mental health engagement gap. But, first, the evidence has to be verified. Given that high bar, how do employers evaluate and compare clinical evidence to choose what will work best for their workforce? The following five questions are a solid guide:

1. Has the specific service or solution, not just the category (i.e., CBT), been tested in a randomized controlled trial?
2. Has clinical research on the solution been published in independent, peer-reviewed journals?
3. What percentage of participants experienced remission in their mental health symptom(s)?
4. What was the effect size of the primary outcome and was it between-groups or within-groups?
5. In what types of populations has your solution been tested?

In addition, a new study published by Forrester Research quantifying the ROI on mental health benefits provides a cost-benefit calculator that can help determine what solution would best fit your company’s needs.

As we move to a post-pandemic world, the need to address the mental health issues that surfaced during the crisis will continue, as will the expectations of the workforce for accessible and effective solutions. Planning for that pending reality now will be vital to providing access to therapies that can engage more people in the treatment of their mental health.