For the past few years I’ve been thinking about preventative healthcare within the overall health and wellbeing space. Asking myself, what is the future of healthcare? From formal healthcare such as doctors and hospitals to less formal like nonprofits, religious groups, peer support, and community centres, they each have their part to play. I’ve narrowed my focus and recently dived deep into the current mental health tech space, specifically mental health apps, in hopes to learn everything I can.
In this series of posts I will attempt to convey what I, as an outsider of the healthcare industry, have come to learn about where the opportunities lie. I’ll explain my viewpoint of new approaches to care and how this relates to what we are building and where we fit.
Spoiler alert, we are coming at this thing with a completely different approach.
But how serious is the issue we are facing? According to the Mental Health Commissions of Canada:
If nothing else changes, by 2041 there will be 8.9 million people in Canada living with a mental
Making the Case for Investing in Mental Health in Canada
health problem or illness that year, representing a slight increase to 20.5% of the projected population. This means that 2.2 million more people in Canada will be living with mental health problems and illnesses in thirty years compared to today. This represents a 31% increase compared to a 26% projected growth in the population 11 and is a significant number in terms of planning future services.
When you’re in the system you’re in the system
Travis Kalanick and Garrett Camp, co-founders of Uber, weren’t taxi drivers, nor were they working for taxi or transportation companies. The founders of AirBnB didn’t own a hotel nor did Musk work for NASA. Come to think of it, I wasn’t a parent until my kids showed up. Disruption often comes, not from those working within, but from the outsiders looking in.
A few years ago, my wife and our 4 small children moved to Sweden for half a year to be with family and have as many Fika’s as possible. Coincidentally this is where Magnus (my co-founder) and I met. Halfway through our trip in the land flowing of strong coffee, cobblestone walkways and IKEA’s, my sister-in-law confronted us. She lovingly took my wife aside and mentioned how we were treating our kids differently. From her perspective, it was clear that we had less patience and grace for one of our kids than we did with the others. Immediately my wife took offense! We flew back to Canada the following day never to talk to them again…. just kidding! We have a great relationship with her and criticism like this we knew came from a genuine place of love.
Before this intervention of sorts we had known there were issues with our parenting. Here was the problem. We subconsciously put on blinders, preventing us from knowing exactly where the issue lay. You could say we knew there was a problem, but we didn’t know exactly WHAT the problem was. Having this outside perspective was freedom from our internal bias. We were able to then address the problem and adjust accordingly. Now we are the very best parents in the entire world with zero flaws… not! But we were able to make small changes that led to a better relationship with our kids.
Outsiders have this ability to see without the fog of being in the system, to think without silos, and build without walls.
As I’ve looked over the proverbial fence, I see fragmentation within the systems of the health sector. Since many are moving towards digital models of care, unfortunately I see this fragmentation moving with it.
Fragmentation leads to inefficiencies, gaps in services, lower standards of care and ultimately a poorer user experience for the end user. The digital shift is forcing service providers to focus more about the end user and their experience rather than traditional norms. Nevertheless, options are plenty and the general public is now in the position to choose their avenues of care. Who wants to be subjected to sit for hours in the waiting room if you dont have to? Those that build their platforms around the end user will see the lions share from this migration and preventative healthcare will be a core driver.
Make room for the new
In 2021 there were reportedly between 10,000- 20,000 “mental health apps” in the app store. The main categories ranging from depression and anxiety management, meditation management, stress management, and wellness management. This staggering statistic shows not only the interest in this space but the broad scope of what mental health can look like. It’s estimated to grow at a compound annual growth rate of 16.5% from 2022 to 2030 with no signs of slowing down. No doubt in part to the unintended consequences of shutting down the world during the recent pandemic. But even before that, society was facing growing challenges with mental health, specifically in teens and young adults.
I’ll be honest, as we’ve tried to convey our ideas of how friends helping friends (or more formally known as peer support) is a key component to the overall health and wellbeing of any individual and society, it’s been difficult for those within the health, nonprofit and educational sectors to grasp. Many can relate to the empowering feeling of friends helping friends and all have had experiences with the utility of this playing out in their own life. But without any previous touch points of this being adopted within their disciplines it can be hard connecting the dots.
You could say they know there is a problem, but they don’t know exactly what the problem is.
As the proportion of Canadians living with multiple chronic diseases increases, we need to assess chronic disease from a holistic perspective that captures multimorbidity and upstream factors, to facilitate broader and more context-appropriate associations with healthy living, quality of life, health care costs and mortality. Special consideration should be given to the role that social deprivation plays in the development of multimorbidity.
Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada
The future of health and wellbeing comes when we look beyond our blinders and understand that yesterday’s approach does not guarantee solutions for tomorrow’s problems. Current models of supply cannot keep up with the increasing demand. Societies unhealth demands a change.
Build for the User
Throughout my biohacking journey with asthma it has become clear that asthma is my body’s response to triggers. Foods I eat, thoughts I have, and external environmental triggers cause my body to have an autoimmune response. My bronchial tubes would constrict leading to shortness of breath. I’ve spent the first part of my life reacting to asthma. I would feel wheezy so I would take my inhaler, problem solved right? Well not exactly. I was never dealing with the root cause of what was actually causing asthma. I never thought past the symptoms.
My thought process was this: me get wheezy, me take inhaler, me wheezy no more, repeat. This worked for a while until it didn’t. Slowly, I began to loose the ability to suppress my symptoms which forced me to address the underlying issues. Since I had never looked past symptom management, I had no idea the level of freedom and opportunity that was available when I dealt with the root issues. It was like someone going to a doctor because they had foot pain yet never bothering to take the pebble out of their shoe. My journey with asthma is just one example of what preventative healthcare can look like at the individual level.
Approach
The overall approach to mental health, and health and wellbeing in general is relatable. We wait until someone is in need of help to then offer programs, resources, and care. Commonly known as reactive healthcare. We get sick, we react to said sickness, we seek care. In the end, healthcare isn’t for healthy people right? Or is it?
Many tech platforms, focused on addressing mental health issues, build around this similar model. The thing is, by positioning yourself so far downstream in an individuals life you remove the opportunity for preventative healthcare or even the ability to address early onset of symptoms.
Let me take you down a typical user journey for someone dealing with a mental health condition. Let’s just say, for imagination’s sake, that you’re a parent of 4 small kids in the midst of a startup. One day you wake up and it hits you, you’re stressed out and anxious! For a good while you’ve been dealing with this but you don’t feel like you need any formal care such as a therapist. You do feel like you need some support though, so you decide to see what’s out there that may help.
When searching for mental health platforms you find they communicate as though you are broken. As you scroll you see a pattern emerge: anonymous chat forms or platforms that just facilite the conversation between you and a professional.
Here’s the thing, you are not broken. Now, maybe you do need the help of a professional or on the other hand you may just need a friend to talk to. You close down your search because you arent ready for professional help and you dont want to talk to anonymous strangers online. You think briefly about taking that vulnerable step and calling a friend out of the blue but more often than not, you try and “push through”. Asking for help or support can be awkward and even difficult. Maybe you just don’t know how or have never done it. Maybe you dont want to look weak or dont know what would happen next. What many dont understand is, by pushing through when you do need help only creates a bigger “tomorrow you” problem. As with my asthma, you are only suppressing symptoms and not dealing with core issues.
After years of pushing through and ignoring the build up of stress and anxiety in our lives, the seemingly ignorable anxiety become’s more serious issue. Once at this stage however, you find a lot of programs, platforms, and supports to help you, and that is great. Support at this point is highly needed but why not address these issues before they get to this stage? This is like encouraging people to smoke until they get lung cancer so that you can then treat the cancer.
Preventative healthcare & bringing it into the public
Platforms today are lacking the ability to empower the natural support structures already in our lives. This is a key component to this future of preventative healthcare. These are the people who really care about our success. It’s our friends, family, teachers, coaches or personal trainers. These are the people we see and interact with in the day to day. Are they not value adders when it comes to our health and wellbeing? Why not empower them to participate. After all, who wants to go through life alone and in isolation from others?
Research has shown the average delay between symptom onset of a mental illness to treatment is 11 years. Your read that correctly, 11 years! This is a symptom of the reactive care approach. It’s our believe that many of these missed opportunities can be solved through user centred design. The continued “build for the system with the end user being an afterthought mindset” is part of the problem. Designing healthcare around the end user will inevitably reduce the burden upon the system, not to mention reduce the financial cost by addressing issues further upstream in patients lives. This is where we see potential in the future of healthcare. This is where we see how we can help to add value.
Past increases in the prevalence of chronic disease accounted for an estimated $211 billion of the $314 billion increase in healthcare spending in the United States between 1987 and 2000 (Thorpe, 2005). Between 2005 and 2030, the number of individuals with chronic disease is predicted to increase from 133 million to 171 million (Horvath, 2002), with profound implications for public health and the economy.
A large proportion of the chronic diseases of concern are preventable, providing an opportunity to exploit prevention as a strategy to bend the curve and reduce growth in disease burden and its associated costs. Fully 38 percent of all deaths in the United States are attributable to four health behaviors (smoking, unhealthy diet, physical activity, and problem drinking).
The Healthcare Imperative
Lowering Costs and Improving Outcomes- Institute of Medicine (US) Roundtable on Evidence-Based Medicine
There are many reasons why waiting downstream is only contributing to the problems we are looking to fix. As mentioned above, waiting for small issues to become large issues only creates, well, larger problems. As a result, more attention needs to be paid on preventative healthcare measures.
The Mental Health Commission of Canada states that:
“If we just reduced the number of people experiencing a new mental illness in a given year by 10% –
something that is very feasible in many illnesses among young people, after 10 years we could be
saving the economy at least $4 billion a year.” The report goes on to say: “A research study in southwestern Ontario on outcomes following a long-term hospital stay evaluated the impact of transitional discharge planning combined with peer support. Individuals in the group receiving peer support were discharged on average 116 days sooner from hospital than the control group who did not have access to this program resulting in an estimated saving of $12 million.”
This is where we see potential as healthcare moves away from the doctors office and into the public sphere. Preventative healthcare is the future and we see peer support (or as we call it friends helping friends) as a critical component. Currently friends helping friends is a vastly overlooked and undervalued component, one which we look to add value into. The result of this oversight is a large gap that has yet to be filled, resulting in an exciting opportunity for change!
So why does it take 11 years from the onset of early symptoms to actually receiving treatment? Well, in the next post I will attempt to explain some contributing factors to this and what we are working on to help with this.
