Changing how we treat and manage mental health
Erik Rehn, neuroscientist and co-founder of Flow Neuroscience, looks at how the COVID-19 pandemic has affected mental health treatment, and how Flow has adapted to changing circumstances.
Global pandemic; mental health epidemic
As a global pandemic gripped the world turning normalcy into fallacy, another crisis has been gathering speed: the deteriorating mental health of the population. Slowly outrunning the capacity of national services and support, this crisis, following the pandemic, is now very much at the forefront of society.
Interest, research, and calls for action have been accumulating since the early 2000s as both awareness, understanding and diagnosis for mental illness were firmly established. Experts were detailing as early as 2018 the devastating effects both personally and economically if more resources weren’t put into the quality of services offered.
Shuttering back to the present day, we can see that this forewarning couldn’t even begin to account for the ripple effects following a global pandemic on the population’s mental health. The latest data indicates that depression rates have doubled since the beginning of the pandemic, yet despite this, diagnoses by GPs have fallen by almost a quarter. This suggests the ability to access mental health care has been impacted, which if sustained would have long term implications on mental health and add further burden to the system. These implications are not too far from view, as NHS leaders underline the gap between the need for care and the current ability to treat patients, with an estimated 8 million people suffering without treatment.
The treatment chasm and remote immediacy
The treatment gap has evolved into a vast chasm with little supply via standard practices to build the bridge. This has meant that alternative solutions developed rapidly to support the burden on the healthcare system with remote and digital-first approaches.
Many companies sought to facilitate this change by adapting products to introduce remote-first applications. However, at Flow Neuroscience, from inception we developed our technology to be an at-home treatment.
Since the beginning, we have strongly believed in empowering individuals to treat their mental health by themselves, hence our ethos and first product, Flow, was built with this in mind - to provide autonomy and accessibility.
Tech development curve & patient surge
In terms of our hardware and technology development, we made no fundamental changes to Flow precipitating or following the pandemic. Instead, it has confirmed our hypothesis of the need for at-home treatments and belief in its design. Having said this, the pandemic fuelled digital adoption and literacy among the population, which has had an impact on the number of people seeking a treatment like Flow.
As access to in-clinic support reduced and waiting lists grew, people needed solutions to support their mental health which could be easily accessed and self-managed. Therefore, a technology like Flow has been able to facilitate patients seeking options whilst the healthcare systems dealt with a global crisis. Over the past years, we saw a sharp increase in patients and to date, we have treated around 4000 people since starting the company two years ago. Whilst we do not see digital technology as a replacement, what we do see is that we can be part of a growing ecosystem for how we treat and manage mental health, placing the patient very much at the forefront.
Having a remote app that delivers behavioural therapy via a virtual therapist whilst you stimulate using the portable tDCS device, meant that many could continue treating themselves even in the peak of lockdown and allowed others to explore more flexibility in treating their depression which maybe they hadn’t considered previously.
De-centralisation and the future
Whilst the pandemic confirmed our approach as a technology delivering remote access to a usually clinic-based treatment, what did drastically change for us was the possibility for doing decentralised trials.
As we develop our technology and hardware for new montages, new treatment protocols and new disorders, we validate the effects across large clinical trials to be able to disseminate these within our product offering. Previously, these trials have been laboursome, requiring participants to be treated in-clinic, using static devices, and limiting the reach and speed of validating research - ultimately slowing down treatment options to support patient recovery.
We have a large trial in Brazil running in collaboration with André Brunoni and the University of Sao Paolo that, during the pandemic, switched completely to being handled remotely. This was quite unique as many peers had to shut down their research; since the Flow technology is designed for remote usage and portability, and the treatment is delivered via the app solution, we were able to empower the research to continue. Similarly, we have been able to support other researchers to continue by switching the devices they used in their studies to Flow and removing the barrier of needing in-clinic stimulation.
Following the slow revival of life, we’ve found that the interest in remaining decentralised hasn’t dwindled. Many of the previous pain points of handling clinical trials and pushing through new research has centred around the need for large scale in-person commitment. Now many stakeholders have acknowledged that high calibre trials can be done without the requirement for physical meetings, with the FDA encouraging organisations to find ways to continue trials during the pandemic.
In terms of the future, we expect to see more large-scale trials, executed quicker, meaning we can update our technology and treatment options for people at a higher rate than ever before. Another thing we expect to see, as more people have become comfortable with digital options, is that we can start to use the data and feedback to build better systems of support, regardless of where a person lives and the level of access they have to care.