Using an app to combat mental illness

Since December 2020, apps have been available on prescription. But to be officially listed as a health app, startups have to meet many requirements. Insights into two young companies that want to hold their own in the highly sensitive field of psychology, of all things.

The psyche is suffering. Not just since the Corona pandemic, but long before. Between 2010 and 2020, the number of days absent from work due to mental illness in Germany rose by 56 percent, according to the latest psychology report published by health insurer DAK. But sufferers often wait months for a place in therapy.

This is a gap that should not exist in Germany. But because mental illnesses are on the rise and there are too few therapy places at the same time, waiting times are getting longer and longer. This seems tailor-made for startups that can help patients in the short term with digital applications. But many young companies are finding it difficult to hold their own on the market in the long term.

In addition to freely available apps that advertise help for psychological upsets, since December 2020 patients have also had the option of relying on a Digital Health Application (DiGa) that a doctor prescribes by prescription. The Federal Institute for Drugs and Medical Devices (BfArM) decides who gets on the list. To be allowed to offer such a service, startups must prove compliance with standards such as data protection and suitability for users within three months. Then they are provisionally admitted.

For "permanent" status, they must submit a randomized controlled trial on the effectiveness of their offering. At this point at the latest, many start-ups fail. Between May 2020 and January 2021, 25 manufacturers of a DiGa withdrew their application for inclusion in the federal government's directory because they could not sufficiently demonstrate quality, function or privacy.

Hanne Horvath is one of the founders currently trying to meet all requirements for permanent listing. She launched her venture in December 2020 with her startup HelloBetter, and now the review process is underway. HelloBetter has a wide range of ten online programs that support people with, for example, depression, anxiety disorders or burnout. The start-up is successful even without being listed: "Our user numbers have tripled in the last year," says psychologist Horvath. Some health insurers already cover the cost of the programs.

"We can often pick people up very early, at times when they are not yet ready to talk to doctors or psychotherapists or to disclose," says Hanne Horvath. (Photo: HelloBetter)

But what exactly do users of the app get? "We're all about helping people make lasting changes to their daily lives, and that's something that's incredibly difficult," Horvath explains. To do this, the programs include breathing techniques, relaxation exercises, strategies against rumination, and other elements from cognitive behavioral therapy, for example. There is also a digital diary. Psychologists accompany users throughout the training and provide written feedback on progress after each session. "This is also for reasons of patient safety: we can't just rely on the program when it comes to depressives, for example, whose symptoms are getting worse. That's where human guidance is critical," Horvath says. Professionals recognize warning signs, contact those affected and offer help.

According to Hovarth, however, the eight- or six-week programs are only intended to supplement or bridge the gap during waiting periods for a therapy place, not to replace it. Digital services, he said, are readily available, unlimited in capacity and less barrier-free for those affected, as they don't require phone calls or initial interviews. "We can often pick people up very early, at times when they're not ready to talk to doctors or psychotherapists or disclose."

There are currently 15 DiGas in the directory, providing services in areas such as cardiology, neurology, ear, nose and throat, and mental illness.

"We're getting reports that patients have developed some sort of relationship with the programs," Michael Keil says. (Photo: Deprexis)

One, of the permanently enrolled applications, has been the Deprexis therapy program since February 2021. The offering comes from the manufacturer Gaia, which has also developed other listed applications in the DiGa directory. Distribution is handled by others; in the case of Deprexis, it is the German branch of the French pharmaceutical company Servier. Deprexis offers the method of cognitive behavioral therapy, also known in analog therapy, for those affected by depression: "Our program is determined by a fixed algorithm. As a user, you answer questions that become more refined and individualized, like a tree," explains Michael Keil, Medical Information Senior Project Manager at Servier. There are exercises, audio players and teaching of techniques for dealing with depressive moods and depression. Crucial to the programs' effectiveness is always an accurate diagnosis by physicians, Keil emphasizes.

The digital offering from Deprexis is intended above all to become a companion in everyday life that provides support and also reminds users when they haven't done any exercises for a long time: "We receive reports that patients have developed a kind of relationship with the programs," says Keil. For example, they wanted to continue receiving text messages and e-mails after completing treatment, asking, for example, which thoughts were positive today, which were negative, and when the last nice moment was.

One problem that both Deprexis and HelloBetter and all the other the applications have: They are not particularly well known. Not among potential users, not in doctors' offices, who can print DiGas on prescriptions. Companies like Deprexis have the advantage of having a pharmaceutical company behind them that does the marketing through existing contacts. Others try to gain awareness through advertising campaigns on social networks: Berlin-based startup Selfaply, for example, recently collaborated with entrepreneur and influencer Madeleine Alizadeh, who promoted the digital therapy offering on Instagram.


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