News /
min read /
December 17, 2021

Daily briefings for mental health?

Colin Espie, Ph.D

We are in a mental health crisis – a global one.

The New York Times published an in-depth feature surveying more than 1,300 therapists across the United States about the state of mental health and what they are hearing from patients. One story from the article stood out to me in particular: Lakeasha Sullivan, a clinical psychologist in Atlanta shared, “I regularly wished aloud for a mental health version of Dr. Fauci to give daily briefings. I tried to normalize the wide range of intense emotions people felt; some thought they were truly going crazy.”

She brings up a great point. We share regular updates for COVID-19 cases and how it impacts our physical health. Why don’t we do the same for mental health?

The scientific community responded to the original threat of the virus by creating vaccines and other lifesaving medical interventions. While I am incredibly thankful for the lifesaving work of frontline workers and researchers around the world to keep us safe and healthy throughout the pandemic, I would argue that mental health care has fallen short when it comes to addressing the crisis at scale.

The COVID-19 vaccines were designed as a solution for all. Now, we are left with an important question: How can we as mental health professionals proactively address the mental health crisis by creating a system that is also available to all?

We know that nearly half of adult Americans have experienced a clinical mental health issue during the pandemic. Yet, we still don’t offer psychological interventions needed for everyone at scale, and in an equitable way. As the article accurately points out, because of high demand, 75% of therapists reported an increase in wait times. Nearly one in three clinicians said that it could take at least three months to get an appointment or that they didn’t have room for new patients at all. If we equate the issue to physical health, it’s like referring someone with a broken arm to a hospital that doesn’t exist.

As a result, the only option for the large majority of people with mental health issues is medications. While medications are an important evidence-based treatment, they are only one piece of the puzzle. According to leading clinical guidelines, including National Institute for Health and Care Excellence (NICE) and the American College of Physicians (ACP), psychological interventions are the first-line treatment for the most common mental health conditions. By only offering medications to those in need, we are ignoring the fact that most people don’t get guideline-based treatment because we simply don’t have a way to supply it.

I believe that the missing piece of the puzzle today is digital therapeutics. Digital therapeutics take proven psychological approaches that are traditionally delivered by human therapists, including cognitive behavioral therapy (CBT), and fully automate them. By delivering evidence-based approaches using pure software solutions, we can scale clinical treatment to the millions of people in need. By adding digital therapeutics to the traditional models of care, therapy and medication, we can essentially redefine mental health care in a way that is accessible by millions, regardless of location, socioeconomic status, or race.

This fall, my home country of Scotland became the first country in the world to make digital therapeutics nationally available to all Scottish adults through their NHS services. Our work with the Scottish government is a major step towards providing critical access to evidence-based first-line care to all people. When applied to other mental health care systems, we can reduce the significant wait times cited in the article. We know that digital therapeutics are clinically proven solutions, and separate randomized clinical controlled trials have shown that Sleepio and Daylight help patients achieve over 70% improvement in insomnia and anxiety, respectively.

By incorporating digital therapeutics into our standard models of care, we can solve the current mental health crisis by scaling access to psychological treatments that aren’t possible through in-person or teletherapy alone. Now, it’s time for all of us to take mental health more seriously by implementing these models at a global scale.

If we aren’t collectively proactive in our approach to providing critical access to mental health support by scaling access to digital therapeutics, we will unearth a “second pandemic” of mental health problems, as noted in the New York Times. We are beginning to see the financial and economic ripple effects of the pandemic with the Great Resignation, record-high inflation rates, supply chain issues and people having to make the tough decision to support their careers or their families. Yet, we’re just beginning to scratch the surface of the emotional and mental toll the pandemic will have on us for generations to come. As quickly as we pooled together resources, funding and support to provide life-saving vaccines to protect us from COVID-19, we need to have the same mentality and vigor towards providing a sustainable life-saving mental health solution to protect us from the growing mental health crisis.

In accordance with FDA’s Current Enforcement Discretion Policy for Digital Health Devices for Psychiatric Disorders, for patients aged 18 years and older, who are followed by and diagnosed with Insomnia Disorder or Generalized Anxiety Disorder by a medical provider, Sleepio and Daylight can be made available as an adjunct to their usual medical care for Insomnia Disorder or Generalized Anxiety Disorder, respectively. Sleepio and Daylight do not replace the care of a medical provider or the patient’s medication. Sleepio and Daylight have not been cleared by the U.S. Food and Drug Administration (FDA) for these indications.

During the COVID-19 public health emergency, Sleepio and Daylight are being made available as treatments for insomnia disorder and generalized anxiety disorder (GAD), respectively, without a prescription. Sleepio and Daylight have not been cleared by the U.S. Food and Drug Administration (FDA) for the treatment of insomnia disorder and GAD, respectively.

1. Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125-133.2. Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., … & Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675-700.3. Wilson, S., Anderson, K., Baldwin, D., Dijk, D. J., Espie, A., Espie, C., … & Sharpley, A. (2019). British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update. Journal of Psychopharmacology, 33(8), 923-947.4. King’s Technology Evaluation Centre. (2017, November 9). Overview: Health app: SLEEPIO for adults with poor Sleep: Advice. NICE. Espie, C. A., Kyle, S. D., Williams, C., Ong, J. C., Douglas, N. J., Hames, P., & Brown, J. S. (2012). A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep, 35(6), 769-781.6. Carl, J. R., Miller, C. B., Henry, A. L., Davis, M. L., Stott, R., Smits, J. A., … & Espie, C. A. (2020). Efficacy of digital cognitive behavioral therapy for moderate‐to‐severe symptoms of generalized anxiety disorder: A randomized controlled trial. Depression and Anxiety, 37(12), 1168-1178.

DOC-3046 Effective 11/2023