Depending on who you ask, innovation is either an exciting word — or a suspicious one. So goes the debate over whether California counties should spend mental health dollars on new technology.
Behavioral health departments all over the state are looking for ways to reach people with untreated mental illness. Many say tech could be the answer, but others are skeptical.
California’s Mental Health Services Act, also known as Proposition 63, distributes roughly $1.8 billion in funding to counties for a variety of programs, including community services, prevention, facilities, workforce education and innovation.
The innovation component makes up just 5 percent of that money. It’s also the only category the act’s Oversight and Accountability Commission has approval authority over.
Toby Ewing directs the 16-person state body, which is largely appointed by Gov. Jerry Brown. He said many counties have been slow to spend their innovation dollars because it can be hard to find a creative project that meets the needs of the community. Counties are also taking their time because the state extended the window that counties have to use the money before it reverts back to the state.
But that clock is ticking — counties had to propose their plans, including the innovation component — by the end of last month and must spend the money by July 2020.
Ewing said many county health directors were looking for guidance on how to move forward. That’s why he reached out to Verily Life Sciences, a research organization owned by Alphabet, Google’s parent company.
He described their work with Verily as “an opportunity in California to leverage what we generally refer to as the innovation sector,” and that the commission “wanted to build stronger bridges between mental health leadership at the county level and our innovation leaders across the state.”
Five counties have already received the commission’s approval for a model they’re calling the “technology suite.” It’s a combination of online therapy using avatars, virtual chat groups and mobile apps that detect a user’s mental health status based on their search habits. Ewing compared it to using a Fitbit for your brain.
Eleven more counties have submitted proposals to join the tech suite. The innovations are largely provided by Silicon Valley startups like Mindstrong and 7 Cups.
Counties feel pressured to spend their innovation dollars, so a ready-to-go plan that already has support from the commission is an appealing idea, said Susan Gallagher, executive director of consumer advocate group NorCal Mental Health America.
But she’s worried that behavioral health departments are just hopping on the bandwagon without actually thinking about what would best serve their patients.
“We have some concern about taxpayer funding going toward for-profit corporations who we feel should be contributing to our mental health system,” she said.
She also described the plans as “more corporate” and was concerned that the tech suites won’t help “the seriously mentally ill that we should be serving with these funds.”
Her organization wrote a letter to the commission asking them to be more transparent about their relationships in the tech world. It also wants the commission to think more carefully about who will benefit from the innovations before approving more county spending proposals focused on the technology suite.
She’s also concerned that these programs aren’t backed by research. And she’s wary about the privacy risk associated with letting smartphone apps track your actions.
Early studies of text therapy and other innovations suggest this technology does effectively improve mental well-being, but is not a replacement for professional mental health help.
The Steinberg Institute, a mental health policy organization that’s pushing several bills to guide MHSA spending this year, also supports the technology suite.
Some rural counties have pointed out that older, isolated people who don’t own smartphones or lack access to the Internet wouldn’t benefit from these programs. And the California Pan-Ethnic Health Network, which advocates for communities of color, said the apps could present a language barrier in some counties.
Ewing said this model won’t reach every mentally ill person in the state. But it might plant the seed for big change in what many see as a broken and overloaded system.
“It’s a small percent of the overall dollars, but it’s a tremendous opportunity to bring about transformational change,” he said.
Innovation funding isn’t only being spent on startup technology. Other counties have proposed connecting rural patients to psychiatrists through video-conferencing, training bartenders to spot suicide signs and educating the community about cannabis.
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