via SciTech Europa: Amid fundraising, PsycApps’ CEO shares the hurdles involved in commercialising a digital mental health game with SciTech Europa.
Digital mental health has proven to be effective enough to consider investing in that area, and NHS Digital has been opening its door to evidence-based applications that treat mental illness.
On Global Mental Health Day, 10 October, the world shifted its attention to an uprising topic of discussion and worry: mental illness, or, with a dash of positive psychology, mental health. Statistics were published that surprised many and shocked a few, the leading message being from the World Health Organization (WHO) stating that depression alone – not all mental illness, only depression – will have overtaken cancer as the number one global disease burden by 2030. A few other statistics were given extra attention, such as the 60% rise of self-harm in young girls over the last four years, and that male suicide is the most widespread cause of death for men under 45.
While it is a wonderful thing that people are becoming aware and speaking up about mental illness, it has become painfully apparent that the demand for mental health care outweighs any resources the UK or the EU may have. A staggering 65% of the population in Europe is without treatment. A natural step, and one the UK government and the NHS have been making for the last few years, is to look for cost effective and easily accessible alternative solutions, the digital landscape offering a whole new dimension of treatment opportunity.
Digital mental health
It is not easy to push forward innovation in this space: there is a lot of responsibility that comes with mental health care, and everyone is being extremely cautious, up to the point of stagnating the progress out of fear. The few digital mental health mobile products that have received funding, like Betterhelp or Superbetter, are not coming from academia; rather, they have been developed by people who have gone through mental illness themselves and are trying to help others like them. This makes these products less likely to be evidence-based, which does not help the cause at all.
The chicken-and-egg-situation is the first and biggest curse that all digital mental health entrepreneurs are struggling with: investing in a completely new and innovative space needs brave investors, dedicated researchers and marketers. If you have a dedicated team of researchers, the probability is that they won’t know a thing about marketing their product, user experience and design. Great sales people with good ideas lack the funding to develop evidence-based products that are trustworthy and effective, and last but not least, investors want traction – they want to see hundreds of thousands of downloads. But how get those numbers without a marketing budget?
The second curse is that of attrition: digital mental health products are often face-to-face therapies like Cognitive Behavioural Therapy (CBT) translated onto mobile platforms. But the biggest success factor for therapies is the face in the ‘face-to-face’: the ‘therapeutic alliance’ or the relationship between client and therapist. Once that is gone, any digital intervention will be more-or-less an interactive self-help book, and for that you need to be very motivated. Unfortunately, motivation, or the lack thereof, is one of the biggest symptoms across mental illness. Cognitive impairment and the lack of drive are highly represented in depression and anxiety, and that is what these apps are trying to help cure.
This is the big problem Silja Litvin, psychologist and founder of PsycApps (a digital mental health game developing company) ran into.
In the course of her PhD at Ludwig Maximilian University, Germany, she developed an app for depression, running it through a clinical trial and proving that using the app on a regular basis for the duration of least a month significantly lowered depression levels. Satisfied with the outcome, she went commercial, only to discover that her users wouldn’t stick to the app long enough to reap the benefits. Amongst the competition of the millions of apps in the app stores, her product simply couldn’t keep the attention long enough to have an effect. This problem is rampant amongst digital health interventions, with mental illness leading the way: if a company has overcome all the hurdles to produce a digital mental health tool, they can barely get their clients to use it, even if it is for their own good.
The gaming industry
This is when she shifted her attention to the gaming industry. In 2018, the gaming industry generated revenue worth more than $100bn (~€86.27bn) in the USA alone. The gaming community is, of course, not exempt from being vulnerable to mental illness, and although many members of this community are indeed mentally ill, that doesn’t stop them from gaming. On the contrary, many self-report that gaming distracts them from their mental illness and allows them a wealth of experience without leaving the safe confinements of their homes. The gaming industry has generated a wealth of knowledge on how to engage and keep players engaged. Litvin was intrigued and decided to use that know-how to help her clients stick to their digital mental health therapies.
To date, we have been unable to find any other emotional mental health games in the app stores. There are cognitive games like PEAK and Lumocity, and mental health apps that use gamification elements to better engage their players, but no actual games.
Litvin believes that this is because people often associate serious games with children and see mental illness as a heavy and sombre topic that doesn’t fit well with playfulness. As a systemic psychologist, she begs to differ: mental wellbeing is all about joy, play and discovery, the key elements of playing a game.
Collaborating with Collision Studios, a game developing company based in Los Angeles, USA, that has worked on heavily commercial and branded games such as ‘The Walking Dead’, ‘Game of Thrones’ and ‘American Girl’, she developed eQuoo, the Emotional Fitness Game based on psycho-education, positive psychology and elements of CBT.
Psychological skills to level up
In the game, players learn two psychological skills per level, the first two skills being ‘Emotional Bids’ and ‘Generalisation’. Once these are mastered, the player goes on an interactive adventure where they need to implement the skills they just learned in order to level up. If you learn something in a fun way, you release dopamine, making it more probable that you wll remember it at a later point. There are personality test questions embedded in the story line as well, giving the player feedback on their personality according to OCEAN, one of the most validated tests out there.
The hypothesis behind learning psychological skills is that having the skills to be able to deal with emotional and mental stressors in life gives you resilience, the biggest prevention against mental illness. This hypothesis is being tested with eQuoo in an on-going clinical trial and the results will be published in a peer-reviewed journal.
Litvin and her co-founder, Med Bukey, launched eQuoo in July 2018, winning four awards over the summer and attracting the attention of news outlets like Forbes and TechCrunch. Their players love the game, giving it 4.9 stars across all app stores and leaving hundreds of reviews. Mental health advocates and psychologists are pushing the game in their networks, including Sharon Blady, the Canadian ex Minister of Health.
Overall, there are extremely positive key metrics and high engagement for the game, promising to have a large impact on the players’ mental wellbeing. Bootstrapping, PsycApps has managed to acquire several thousand users since their launch and are actively looking for distribution partners. To scale the game and add evidence-based therapeutic game features that treat low level depression and anxiety, they are now looking to raise a seed round, but are challenged with finding investors willing to invest in this new and uncertain space. Indeed, Litvin says that she has met several investors who are very interested, but they are wary to make the first step.
Though the behavioural health software market will reach $2.4bn in the next four years, the industry needs pioneering and courageous investors and political supporters to push things forward.
If you are looking to invest in a promising social impact space, PsycApps and its fellow businesses could be the way to go.