The 3 problems with virtual mental health services

Portrait de Quayce Thomas

A good virtual service helps you discover a reason to work hard. It helps you see that getting better is possible, and is within your ability. It offers support and encouragement to move forward. It promotes interaction with people, places and experiences. It connects you with who you are and helps you become who you want to be.

After going through the mental health system several times over, I decided to build my own.

As a child, eczema caused my skin to crack and bleed. Bad asthma put me in and out of hospital for months at a time. Inflammatory problems in my lungs, brain, face and knees meant I got well acquainted with the staff at the Children's Hospital (CHEO). By high school, I tracked my symptoms daily, and adjusted medication accordingly. My mom is a physician, and we are the kind of family that goes for a run on Christmas Day. So, even before I became mentally ill, I knew how to manage illness, and I was well connected to the health system – but even that did not guarantee a smooth healthcare experience.

When your brain stops working properly, you’re the only one who can’t see it. We built our health systems for broken legs and stomach pain  —  conditions where the brain was reliable to make decisions that would help the body recover. Trying to force a sick brain to be a healthy brain so that you can make it a healthy brain doesn’t work. It makes things worse.

And so, in order to get better, I needed to build a different kind of health system — one that was compatible with people who were going through mental illness. Through my journey of building my mental health service, “Timsle.com”, I’ve had the opportunity to go through the challenges of building a good virtual mental health service.

I believe, there are 3 problems with the current virtual mental health services:

  • They rely on limited resources,
  • They are built on old business models, and
  • They aren’t useful.

They rely on limited resources.

During the years where I was most sick, I needed support almost every day. I lived within walking distance of my clinic. Going anywhere too far was risky. And in states of mania, I needed to get away – usually without notice, and entirely out of reach. Mental illness is extremely consuming and demands care services that can be offered in an “unlimited” way.

Even the most modern systems today are built on networks of limited resources. Examples of limited resources include:

  • Geographical Resources: Anything embedded in land such as hospitals, infrastructure, research labs, cities and physical schools.
  • Human Resources: Anything that involves people doing work which requires training, such as doctors, nurses and administrators, and help phone volunteers.
  • Physical Resources: Anything that can only be useful to you if you have physical access to it, such as medication, wearables, etc...

Naturally, these limited resources can’t be everywhere at once, leading to limits which constantly drive up the cost of care, making them less and less available for everyday use in everyday places. These limits include:

  • capacity limits: they can only serve a certain number of people,
  • concurrency limits: they can only serve a certain number of people at the same time, and
  • geographic limits: they can serve people living in certain areas.

A virtual service gives us a meaningful opportunity to explore “the unlimited”. When services are virtual they come with us – we can use them at home, at work, on vacation and in a nightclub. They are available 24/7, and they are embedded in the tools that are always within reach.

A good virtual service works:

  • in bed at home,
  • in the emergency room of a hospital,
  • At night, in the middle of the woods of the city you ran off too.

They are built on old business models

Looking back, I now believe my descent into psychosis, depression and substance abuse could have been avoided. But at the time, I didn’t know what to look for, my family didn’t know what was happening, and we didn’t understand how bad things had gotten until campus security put me on suicide watch, and I was on the way to the hospital. It seemed like it happened suddenly, but it didn’t.

The reality is, healthcare is expensive and our health resources are stretched to the limits providing care to people who we know how to help. Unfortunately if you’re not at the point where you might kill yourself, you often don’t meet the criteria for care.

In order to get out of this cycle, we need to challenge the lifeblood of the system: the Provider, Patient, Payer business model. It seems great at first:

  • The provider gets a good pay for good work,
  • The patient gets a good service, for little pay,
  • The payer gets good work for a small payout.

When it comes to virtual services, we aren’t dealing with limits. Everyone can have an app for free. The knowledge of one doctor can be deployed an infinite number of times, concurrently. When we make virtual services compatible with economic models designed to handle finite resources, we end up taking away the thing that made them so valuable in the first place - accessibility.

As an example, “Instagram” is the ultimate virtual magazine service. Anyone, anywhere, anytime can pick up their phone and enjoy a curated magazine experience once reserved for people paying $12 to get physical newsfeed print-outs shipped to them. If Instagram had built their service so only New York Times, National Geographic and Sports Illustrated could publish content, it would have fit with the business models of the time, but it wouldn't have lowered the barrier of access to curated entertainment, and it wouldn’t have been adopted by 1 in 7 humans.

And so, a virtual health service is one that I can use if I want to use it, because it offers something I want. It allows everyday people to participate in something that wasn’t accessible to them before.

They aren't useful.

One of the biggest tensions between myself, my parents and my care team was the definition of “better”.

Before illness, I was a student body president, top of class, hard worker and loved to build things. Success was working hard, having fun and being involved. After psychosis, success was not being admitted to hospital on Form 1. For my parents, “better” was back to how I was before illness. For my doctor, “better” was not admitted. For me, “better” was not being pulled around by all these things I could not control.

With mental illness, everything in my life changed - my interests, my abilities, my thoughts, my trajectory, and sense of self. The way I used things changed too. Instead of using my bed to recover from my day, I used it to hide from my day. Instead of using the internet to learn, I used it to find a sense of belonging. Instead of using medication to get better, I used it to feel better.

A good virtual health service is one that operates that level of general usefulness. Examples include your bed, Google, and alcohol. These can prove their usefulness no matter how you feel. The way you use it changes based on what you need from it. In mental illness, we’re dealing with brains that aren’t working. As developers of mental health apps, we don’t get to pick the users state of mind when they interact with our service, and we really don’t know if they need the same thing that helped them yesterday.

For the first few months of life on the depressed side, I tried so hard to find an app that could be useful to get better. The worst apps were CBT apps, with their constant logs showing me how depressed I was. In pitch competitions I never understood the comment “I wouldn’t use that, but I would if I had depression.” You don’t sign up for depression - and so if you aren’t already using it everyday, you’re definitely not going to start after diagnosis.

Other services attempt to be useful to the providers. Clinical video calling apps make it easier for providers to see their patients. They are solutions that require patients to have problems to be viable. They aren’t innovative - they are band-aids for unsustainable ways of doing things that will reveal more problems instead of more solutions.

And other services attempt to be useful to the payers. Employee wellness programs, tracking dashboards and campaigns just create more need for more stuff that costs more and does less, adding yet another thing to our to-do lists. Things that are useful create new economic opportunities. Things that are useless spread our limited resources even further apart.

The future of healthcare is self-care.

Our current systems work backwards. First we identify the illness, then we work backwards, treating each symptom. We pass off the bill to the payers, who pass it off the people, who manage the stress burden through habits that make them need more care. It's a vicious cycle, and it is hard to go the other way.

Anyone who’s gotten better at anything or from anything  —  whether it's depression, public speaking or figure skating   —  will tell you a similar story: “I didn’t get better overnight. I worked hard, took care of myself and did what I needed to do. I made decisions over and over again that I didn’t want to. It was hard, because my mind, body and environment were working against me. But I did it because I wanted to get better — I needed to get better.”

A useful virtual health service is one that can help us get better in that unlimited way — one that works anywhere at any time, for anyone in any place. It costs pennies per million, instead of millions per square mile of coverage.

A good virtual service helps you discover a reason to work hard. It helps you see that getting better is possible, and is within your ability. It offers support and encouragement to move forward. It promotes interaction with people, places and experiences. It connects you with who you are and helps you become who you want to be.

It’s easy to use, and works on your schedule. You use it because you want to use it, and you find it useful in your own way. After trying hundreds of apps, groups, services, and other offerings, I realized it would be faster for me to learn to code and build a virtual health service that worked for me, rather than to wait for one to come along.

It’s 2020 now, and industries everywhere are exploring the power of virtual services. Lying down on my couch, I can hang out with friends in another city. I can shop at a store in another country. I can watch astronauts leaving for another planet in futuristic space shuttles. But, if I am having a mental health problem, I join the lineup to hurry up and wait for help that’s going to cost us more money than we have.

Portrait de Quayce Thomas
About the author

Quayce Thomas

Quayce Thomas is the Founder of Timsle, a social accountability network he built after being diagnosed with bipolar disorder and psychosis while studying architecture. Through Timsle, Quayce explores how data and technology, combined with the support of friends and family can help others with mental health disorders functionally overcome their illness as well.
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