Deploying a mental health app for underserved populations

Selecting the right technology

Accelerated by the COVID-19 pandemic, virtual healthcare has been rapidly adopted nationwide, particularly in the mental healthcare arena. Even as telehealth utilization fell overall between 2020 and 2022, the share of telehealth visits for behavioral health conditions jumped from 41.8% to 62.8%.

Further, research has highlighted how digital health apps can support patients experiencing delays in securing initial mental healthcare appointments, offering an effective stopgap.

Thus, when MyCHN leaders began noticing a significant uptick in behavioral and mental healthcare needs during and after the peak of the pandemic, they decided to explore a digital healthcare option to meet the growing needs of their patient population.

"We're getting a lot of, what I like to call, population pandemic -- regular people that are struggling with their emotions, emotional regulation, their anxiety and depression, isolation, loneliness, those sorts of things are more of what we're seeing now that we treat," said Demi (Demeatraus) Minter, the FQHC's chief behavioral health officer. "That's one of the things that led us into partnering [with a digital mental health company]."

The FQHC began assessing various digital health tools available in the market. The center identified the non-negotiable features that the app must have, including HIPAA compliance. Minter noted that offering confidential care to patients and mitigating the stigma related to seeking mental healthcare was critical for the FQHC.

"So, we did do our homework and checked out the digital platforms that were being offered at that time, and we found that Wysa was able to work with us and the needs of our patients and provide that level of confidentiality with evidence-based, validated and tested [services]," Minter said.

Exploring the features of the mental health app

Wysa offers an AI-powered app that is designed to address stress, anxiety and chronic pain, among other mental health conditions. The app, which has received FDA breakthrough device designation and is on the pathway to FDA approval, includes a chatbot and more than 150 self-guided, interactive mental resilience exercises.

Per the partnership, MyCHN patients can access the chatbot, learning modules and Cognitive Behavioral Therapy (CBT) exercises, as well as the mood tracking feature that provides insights into emotional well-being and an additional licensed module to treat symptoms of insomnia, Wysa's Chief Clinical R&D Officer Chaitali Sinha said.

First-time users are guided through the app set-up process, where they can choose a nickname for their profile, select which concerns they would like assistance with and indicate their preferred therapy style, whether working through challenges solo or guided support with a coach.

Users can anonymously use the chatbot 24/7 to address their issues independently. The chatbot leverages machine learning to provide users with mindfulness and cognitive behavior practices. 

"The answers provided by Wysa’s Chatbot are based on the structure and protocol of cognitive behavioral therapy and are written and vetted by mental health professionals," Sinha explained.  "LLMs [large language models] are used to provide a more personalized and contextual answer within that structure. Wysa then adds non-LLM guardrails for both user input and chatbot output to prioritize user safety and clinical protocols. These include using non-LLM AI to classify user statements for risk and deeper vetting of potentially high-risk statements."

For users who prefer guided support, the app offers live, text-based chat sessions with a personal coach.  

Wysa has conducted numerous clinical trials, real-world studies and service evaluations showing that the app is effective in helping people address mental health conditions like depression,  anxiety and chronic pain.

Patient feedback reiterates the app's benefits. For instance, Minter shared that one of her patients with Huntington's disease, a neurodegenerative brain disorder, has found the app's library of stories immensely helpful in falling asleep.

Further, Minter emphasized that the app's data privacy and security features were part of the reason the FQHC selected Wysa for its patients.

Sinha shared that users are completely anonymous when interacting with the chatbot, and any inadvertent personal identifying information shared is automatically deleted within 24 hours. Wysa's data is protected by TLS encryption protocols, and its storage servers use industry-compliant AES-256 encryption protocols.

"Also, when users set up Wysa, they are required to set a PIN in the app settings to ensure only they can access private chats with Wysa," she said.

These features enable health centers like MyCHN to provide secure and anonymized mental health support to its vulnerable patient population, which could also help destigmatize the process of seeking mental healthcare.  

Deploying the mental health app equitably

Once MyCHN partnered with Wysa, the FQHC began developing strategies to equitably roll out the mental health app across its 14 Texas-based clinics, which serve approximately 144,000 patients. 

Minter noted that patient education and raising awareness about the app have been critical to an equitable deployment. The FQHC sent out text messages, posted on their website and had screens announcing the app's availability in their brick-and-mortar locations. But uptake remained low because patients did not understand how to use it.

"So then, we had to take a step back, and we identified staff that could work directly with the patient," she said. "Not just giving [the app] to them, even walking through how to download it, how beneficial it could be for them in addition to their in session. So, we really educated patients on using it, [and] there has been a huge uptake in our patient population."

She added that the proportion of behavioral health patients using the app has jumped more than 50% in the last month from two months ago.

Another barrier was cost, especially for underinsured and uninsured patients. MyCHN eliminated this barrier by offering the app to its patients for free. Minter said that the FQHC purchased multiple licenses for its population, which allows it to take the cost burden off the patient.

The feedback to the app has been overwhelmingly positive, with patients loving the real-time support, Minter said.

Additionally, the app has helped MyCHN reach a wider swath of patients amid workforce shortages in the mental health arena. With the mental health app, patients no longer have to wait until they can get an in-person appointment with a mental health professional, which can severely restrict patient access to mental healthcare.

Seeing the app benefit MyCHN's communities, Minter hopes the center can offer digital health tools to support primary and specialty care as well. But, for that to happen, federal agencies need to widen reimbursement and make services provided via digital health apps billable.

If the push to include digital health tools in the standard of care succeeds, gaps in patient access, particularly within mental healthcare, could narrow. This would significantly expand the benefits of telemental healthcare.

"Being able to provide not just the access for people that are on the waitlist, but also the fact that it's offered for free so patients can access it whether they have insurance or not, whether they're out in a rural community and have transportation challenges -- that's a huge benefit," Minter said. 

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.