When patients sign up for the newest kind of therapy at the Mental Health Center of Denver, here’s what comes in their welcome packet:
A biofeedback device that clips to their ear to measure pulse and blood-oxygen levels. A phone stand to prop up a smartphone during therapy sessions. And directions for downloading an app to chat with a therapist.
It’s a new era in technology for the community mental health center, a key step toward “preparing for the next generation,” said Alires Almon, the center’s director of innovation. The 12-week, virtual therapy program isn’t meant to replace traditional face-to-face counseling — it’s a contemporary option for people who would rather work on their mental health at home with their smartphone than walk into a mental health center.
“People want something where they can engage on their own terms,” Almon said. “No one has to know that you are in therapy. It gives people an opportunity to engage in a private way.”
Participants join a cohort with 10 to 12 others, classmates from across the country who are logging on for group therapy, individual chat and talk sessions, and training in how to meditate, fall asleep and use breathing techniques to decrease anxiety.
“You could be there with a housewife from Maine, a salesman in Seattle, a teenager in New Mexico,” Almon said. “You don’t even know their names.”
More than 30 people have signed up for the therapy so far, and the mental health center’s first clients to start the program joined a cohort about two weeks ago.
The project is a partnership with California-based tech company Meru Health. The Mental Health Center of Denver refers patients, but the virtual therapy comes from one of Meru’s 45 therapists working across the country, including in Colorado.
The first 40 participants are funded through a $58,000 grant from Gov. Jared Polis’ Office of eHealth Innovation, but mental health leaders are hopeful that, if it’s successful, the state Medicaid department might someday fund smartphone therapy the same way the government insurance program pays for in-person and virtual behavioral health visits.
The program tracks patients’ mental health status — using the standard seven- and nine-question tests for anxiety and depression — every two weeks. Meru also has partnered with Stanford University and Cigna insurance company, and initial studies have found that nine in 10 people complete the program and eight in 10 have improved mental well-being by the time they finish.
Participants, on their own time, complete mental health tutorials that are tailored to their own issues, most likely focused on either anxiety or depression. Each week has a different theme for learning how to cope — one week is cognitive behavioral therapy where clients learn how to get rid of recurring negative thoughts and another week is about sleep habits. Other topics include diet and nutrition, and meditation techniques.
While using meditation or breathing tutorials on the app, clients can clip their biofeedback monitor either to an ear or a finger. The monitor is connected through Bluetooth to the person’s phone and collects data on their pulse and blood-oxygen levels.
“We are visually showing you how taking those 10 deep breaths is impacting your body,” said Brett Shrewsbury, Meru’s chief commercial officer.
The therapy begins with a one-on-one televideo call with a therapist. After that, the therapist and client stay in touch through the chat function on the app, and if the therapist doesn’t hear from the client for longer than a day or two, the therapist tries to connect via texting or a phone call.
The average time people spend on the therapy is about one and a half hours per week, or about 20 hours of interaction with the app during the 12 weeks.
“What we are trying to do is to keep it easy and make it not scary,” Shrewsbury said.
The setup helps solve the “big math problem in mental health,” which is that there aren’t enough therapists for the number of people who need therapy, Shrewsbury said. One in five people at any given time have a mental health or substance abuse disorder, according to behavioral health studies. So in Denver, that’s about 144,000. Yet the Mental Health Center of Denver saw about 21,000 people last year.
One virtual therapist can work with five times as many people as a therapist who sees patients one-on-one.
Meru, founded in 2016, plans to have 100 therapists on staff by the end of the year. It already has therapists in 16 states, with the most based in Colorado and California, Shrewsbury said. The founders of the company all have backgrounds in tech and were touched in some way by mental health. CEO Kristian Ranta, who also started a Finnish melodic death metal band, lost his brother to suicide in 2005.
The Mental Health Center of Denver is targeting patients for the program who come in for monthly psychiatry appointments to get prescription medication but who are either waitlisted for talk therapy or have said they aren’t interested in therapy.
The virtual program isn’t for everyone, said Wes Williams, who is chief information officer for the mental health center. Clients who are suicidal, those who need face-to-face support and those who are so sick that they aren’t meeting their basic needs — including housing — likely are not good candidates, he said.
About 90% of the center’s clients have smartphones, but fewer than that have regular access to the internet, he said. Most clients have Medicaid or no insurance, although about 2% pay with private insurance.
The three-month virtual program is one of the multiple projects on the mental health center’s digital innovation list.
Another project — now on hold because of coronavirus — is for patients who have social anxiety or social avoidance. Instead of going out into the real world with a therapist or peer navigator who can coach a person through social situations, a client puts on a virtual reality headset during a therapy session.
While the person is in VR land, perhaps walking onto a city bus and trying to find a place to sit among a group of angry-faced strangers, a voice in their ear talks them through the process.
That therapy program was suspended until the mental health center can return to in-person appointments. Since March, therapy appointments have occurred via telehealth, and the virtual therapy headsets were used during in-person appointments.
Through another project, clients can sign up for a chat-text program to keep in touch with their therapist in between face-to-face visits. The program uses an algorithm that detects key words and asks automated questions — such as, “On a scale of 1 to 10, how is your mood today?” Answering a 1 or 2 would trigger a conversation with the therapist. The point is to keep tabs on clients’ mental health, and force them to think about their well-being, outside of weekly or monthly visits.
Almon sees the digital therapy projects as a complement to the rest of the center’s work, and a way to get people who are shy about therapy or concerned about the stigma of walking into the center to sign up for mental health help.
“The culture has dictated an expectation of what care looks like. Everything should be personalized for you,” she said. “It’s all about catering to you. It fits into our model of meeting people where they are.”