The Big Read

Tech companies see digital therapy as a way to reduce Canada’s $50-billion annual cost on mental health

Ontario Premier Doug Ford applauds as Lt.-Gov. Elizabeth Dowdeswell delivers the speech from the throne to open the new legislative session at the Ontario Legislature at Queen's Park in Toronto on Thursday, June 12, 2018.
Ontario Premier Doug Ford applauds as Lt.-Gov. Elizabeth Dowdeswell delivers the speech from the throne to open the new legislative session at the Ontario Legislature at Queen's Park in Toronto on Thursday, June 12, 2018. THE CANADIAN PRESS/Frank Gunn
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During the recent Ontario election, newly-elected Premier Doug Ford campaigned on a promise to spend $1.9 billion on mental health and addiction over the next decade. The funding—matched by the federal government, and confirmed in Ford’s first throne speech earlier this month—was a recognition of the strains placed on the healthcare system by the one in five Canadians who face mental illness every year.

Canada has long trailed its international peers in the provision of mental health services, and equally lags behind on making available innovative treatments. But a nascent segment of technology companies are hoping to change that by reducing the costs and stigma of treatment for patients. In doing so, they argue that they’ll help to reduce the more than $50 billion spent on mental health care every year.

Research suggests that only about 1.5 per cent of the population need highly specialized services, meaning most of those who face a mental illness each year can be adequately served by scale-able solutions. Tech companies providing therapy services online—which has worked to varying degrees in Finland, the U.K. and Australia—are now emerging in Canada.

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Talking Point

Mental illness costs the Canadian economy at least $50 billion annually, but a growing number of Canadian tech companies are hoping to change that through digital therapy. Already in use in the U.K., Finland and Australia, these services are reducing costs and removing traditional barriers to access.

New to the fray is Beacon, a digitally-focused technology subsidiary of CBT Associates that launched last fall. The Toronto-based company provides cognitive behavioural therapy (CBT) through its own digital platform from assessment through to treatment, and places patients with a dedicated therapist.

“We start from a rigorous assessment that puts people into the appropriate care,” said Colin Andersen, Beacon’s Executive Vice President.

On July 3, the company announced it had expanded its services nationally, and is now offering therapy in both English and French.

“A typical course of treatment for depression would be 16 to 20 treatments, which would be roughly $3,000 to $4,000,” said Andersen. “We’re able to bring that down to $800 for assessment and treatment, or $500 for someone who just goes direct in to treatment.”

Andersen is careful to point out that Beacon is a platform, not an app; whereas an app might be programmed so a user can complete certain tasks, the platform connects users to a dedicated, human therapist who guides them through proven CBT practices catered to them. While some governments, including British Columbia’s, recommend certain apps for mood and anxiety, research has found that many fail to produce effective clinical outcomes.

Ontario currently offers telepsychiatry, but it has not been widely adopted. A 2017 study in The Canadian Journal of Psychiatry found that fewer than one per cent of patients saw a psychiatrist through telepsychiatry.

On the other hand, online CBT has withstood scrutiny. 

“At this point the literature is getting very robust, which is a very fancy way of saying these experiments have worked,” said David Gratzer, a psychiatrist at the Centre for Addiction and Mental Health and a professor of psychiatry at the University of Toronto.

“Sometimes things are cutting-edge and they sound cool, but they don’t really work. But big papers published in places like The American Journal of Psychiatry show that internet delivered cognitive behavioural therapy can rival in-person therapy.” said Gratzer.

Morneau Shepell, the country’s largest employee and family assistance provider, launched its own internet-based CBT program in May, which it said will tap into a network of 3,000 clinicians.

“The convenience of digital therapy means a better user experience and an increased likelihood that the user continues their therapy plan, which means better outcomes and a return to health and productivity,” said Rita Fridella, an executive at Morneau Shepell.

Meanwhile, Alavida, a Vancouver-based startup, offers internet CBT alongside other programs to treat alcohol use disorders, based on Finland’s ContrAl Clinics.

Richard Andrews is the founder and CEO of Healios, an online service that connects people in Britain to therapists over video. Healios is now available through 20 of England’s 53 mental health trusts. Andrews said partnerships with the country’s National Health Service are beginning to show results.

“From our perspective, efficiency encompasses many elements,” he said. “The first element is bringing direct cost savings: instead of face-to-face CBT, you can deliver that remotely—still clinician-led—but you’re making the clinician more efficient in that they’re seeing more patients in a week.”

Another element he noted is capacity, which is particularly relevant to Canada where rural and Northern communities and people of low-income backgrounds have less access to services.

“The current mental health model is very much about trying to recruit local clinicians and that’s costly, it’s time consuming and not very efficient,” Andrews said. “Through technology you can bring a national workforce, a national capacity to sort and deal with local demand, because various clinicians can work around the country. That in itself creates better capacity to deal with local demand.”

Andrews said it’s not there yet, but soon enough digital health efficiencies will mean infrastructure savings, too: “You’re not going to need such big buildings.”

Australia has perhaps most aggressively pursued the rollout of internet-based mental health services. One example is MoodGYM, a previously free (now A$39 annually) computerized CBT program that launched in 2001 and has had over one million users register globally.

Research has found it to be effective for reducing depression and anxiety, but drop-out rates are high, and uptake has been lower in rural areas.

“The public return on that investment hasn’t been as good as something where we assess somebody more accurately and assign them to the appropriate care right off the bat,” said Andersen.

To that end, MoodGYM has begun to introduce programs that, like Beacon, are therapist-guided and not solely computerized.

Mental Health Statistics

  • One in five Canadians face a mental illness every year.
  • By the time Canadians reach 40 years of age, one in two have or have had a mental illness.
  • Canadians spend almost $16 billion a year on mental health care.
  • Mental illness costs the Canadian economy over $50 billion a year.
  • 7.2 per cent of Canada’s total health spending goes towards mental health—well below Canada’s G8 peers: England’s National Health Service (NHS), for example, spends thirteen per cent.

 

Source: Mental Health Commission of Canada, 2017

In Canada, Gratzer led an internet CBT pilot at the Scarborough and Rouge Hospital in Toronto, which ended up having an attrition rate seven per cent lower than in-person therapy, and noted significant improvements in measures of depression, anxiety and stress.

“We were able to reach patients that ordinarily we wouldn’t have reached,” he said. “People with more minor illnesses would participate. The younger set seemed to prefer this—they do everything on their smartphone, so why wouldn’t they do their therapy on their smartphone?”

He also said some patients who had conditions that made it difficult for them to access in-person care, such as one who had social anxiety and struggled to ride public transit to the hospital, were able to more readily participate in treatment.

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Healios CEO Andrews believes that the data captured by digital platforms will assist therapists in developing more objective assessments of their patients. “Words that people are using, social media profiles, analyzing their voice patterns, looking at how they’re engaging on their phone, looking at what kind of photos they’re posting—you can gather that data, which is much more objective and doesn’t rely on memory recall like a lot of therapy.”

“I think that’s one of the most exciting things about psychiatry in the next five years is, finally, we’re going to start bringing in objectivity in what will be the equivalent of biomarkers.” said Andrews.

Premier Ford announced Monday that part of the funding allocated for mental health and addiction will now go to police, to help first responders deal with mental health issues and to offer de-escalation training.

Mental health experts like Gratzer are hoping that some of the funding and private investment will be funneled towards digital therapies.

“Given the convenience, given the lower cost—given all of these things, it’s the sort of thing we should be all over in Canada.”