The future of mental health care: Managing more with less

We often hear people talking about how the healthcare system is broken – especially mental health care. Usually, people are referring to issues with access to care, costs related to care, and other barriers that prevent people from getting the care they need.

But what if it’s not just the system that’s broken, but how we think about mental health and mental health care to begin with?

When we talk about mental health, we tend to focus on symptoms of poor mental health, like depression or anxiety. When we assess the effectiveness of mental health care, the focus is almost always on symptom reduction, usually in a sample of people who had elevated levels of those very symptoms to begin with. And it’s table stakes in the digital mental health space to show how much improvement you see in depression and/or anxiety among users.

These symptoms are undoubtedly important. In our research, we’ve found that 40% of U.S. adults report at least mild symptoms of depression, and 44% report at least mild symptoms of anxiety. Experiencing either of these symptoms increases both direct and indirect costs, posing a significant economic burden – and experiencing them together increases those costs even further. So reducing these symptoms means reducing the associated costs.

But our laser-like focus on symptoms of poor mental health means we’re overlooking the majority of the population, who by this definition are doing “well”. And when we define effectiveness of mental health care only in terms of symptom reduction, we make the mistake of assuming these individuals can’t benefit from mental health care because they have no real symptoms to improve (this is what we scientists call a “null” effect).

Mental Health Isn’t Just the Absence of Mental Health Disorders.

Although we tend to focus on the negative part of the mental health continuum – mental health is more than the absence of symptoms of a disorder. There’s a lot of room between not having symptoms of depression or anxiety and having good mental health.

Positive psychologists have been interested in this part of the continuum for decades, focusing less on symptoms and more on positive aspects of mental health like subjective well-being (the scientific term for happiness) and resilience. And according to one positive psychologist, Corey Keyes, the real goal for mental health is flourishing – which means you feel good about your life, and you’re functioning well. Others have argued that positive mental health means achieving a sense of internal equilibrium – and that what this equilibrium looks like may change over time.

In other words, it’s not just about treating symptoms. What we should really be striving for is helping people achieve this state of flourishing or internal equilibrium.

But unlike physical health, we rarely talk about promoting positive mental health or preventing mental health disorders. With physical health, we don’t just talk about the people with diabetes or heart disease – we tell people they should exercise at least 150 minutes a week to maintain “good” health. We give people specific recommendations for heart healthy eating. We follow influencers who are models of “good health” and aspire to be like them. So why don’t we do the same when it comes to mental health? Why not talk about the ways of promoting good mental health, rather than simply treating a problem that already exists?

This requires a perspective shift – a shift from viewing mental health only in terms of mental health disorders to embracing the full continuum of mental health. And if we can make that leap, then promoting positive mental health isn’t just about symptom reduction, but about encouraging people to adopt healthier emotional habits and helping them to develop skills like empathy, emotion regulation, and resilience, which researchers view as key components to achieving internal equilibrium.

Digital mental health interventions may be particularly well-suited to helping individuals learn and develop habits around these skills, something Dario’s Chief Medical Officer, Dr. Omar Manejwala, recently wrote about in STAT. As Dr. Manejwala aptly writes, digital solutions are not medicines – and correspondingly, we need to stop evaluating their benefits solely in terms of how well they can reduce symptoms of depression and anxiety. By doing so, we’re undervaluing the benefits of many such interventions.

Instead, we should also be asking ourselves: how much does this intervention increase empathy and resilience? How does it improve cognitive, social, and emotion regulation skills? And does the intervention help to develop other behaviors that drive psychological and medical health? Without considering these other outcomes, we’re overlooking the cost savings associated with promoting these behaviors – cost savings that aren’t just expected in the proportion of adults with depression or anxiety symptoms, but across the full continuum.