Top 4 Mental Health Trends to Watch in 2023

Red Hot Growth of EMDR Based Apps

Eye-movement desensitization and reprocessing (EMDR) is a therapeutic technique for addressing trauma and other mental illnesses.

Right now, demand for EMDR is at an all-time high and is expected to increase. Google searches for the term “EMDR” has doubled over the past two years, whereas other generic searches for therapy are roughly the same over the same period.

There is a new wave of understanding of how trauma can have an impact on anxiety, depression, or other life experiences. Many people are starting to realize that some of their experiences would be considered trauma to a mental health professional and are wanting to address this with a technique that helps achieve a state of readiness toward peaceful resolution.

New awareness of trauma-informed care has led to an intense demand for EMDR therapy. Mental health professionals feel that EMDR is very effective and whenever there is a spike in demand, the market seems to try to capitalize on the sudden wave of interest with new apps.

A search on Apple’s app store reveals more than 20 apps so far which claim to assist with self-administered EMDR. But are there dangers to self-administering EMDR?  

Training for EMDR is very complex for a seasoned therapist. To attempt to do EMDR on your own may give a false impression of the lack of efficacy of EMDR since it is not the way that EMDR was initially designed. Thus, the harm from such apps would be indirect as they would
cause patients to miss out on an opportunity for more effective therapist led EMDR. But the EMDR apps could help some with mild cases seeking treatment for trauma-informed care.  

Keep on the lookout for more EMDR apps in 2023.

Tapered Expectations of Artificial Intelligence and Genetic Testing

I don’t believe that we are going to see significant advances with AI in mental health in 2023. AI as a standalone therapy entity is going to throttle back for a while. I don’t think we are ready for an AI bot as a full-fledged therapy option. There is a growing trend toward a consumer desire for digital media to convey closeness, warmth and transparency. Tiktok is driving this movement with raw, unadulterated, soul-bearing confessionals from laypersons, professionals, and celebrities on mental health topics. This is the opposite of what a bot could provide right now.

I believe that in 2023 AI may make take a stronger foothold into the back engine of EHR systems. For example, a bot could aid clinicians with the process of handling patient messages in a patient health portal. Many patient messages pertain to rescheduling appointments and refilling medications. This could be detected by a bot and next steps could be queued up for a clinician to review and approve more quickly.

Similarly, genetic testing had caught much momentum in 2020-2021, but there has been a better understanding that genetic testing does not reveal as much actionable information as originally expected.

For example, genetic testing may yield results about a certain individual’s metabolism rates of some medications. However, the metabolism rates may be classified as ‘intermediate,’ which leaves the patient and clinician with an equivocal decision-making tool. Furthermore, some
patients may have significant side effects from a medication they are a poor metabolizer of, and vice versa, making genetic test not as informative as one hoped.

This trend reflects my clinical experiences where fewer and fewer patients are asking for genetic testing compared to two years ago.

Cooling Off of Venture Capital-Backed Mental Health Platforms

Venture capital-backed mental health platforms have seen explosive growth over the past two years. Driven by money-making potential, overall investments in US-based digital startups doubled from $14.9B in 2020 to $29.1B in 2021. In the midst of polished marketing campaigns, negative press is starting to catch up and some are under federal investigation for prescribing practices.  

I am “all-in” for increased access to care and lowering of costs for patients. I also feel that VC-backed apps do good for the reduction of stigma and overall normalizing mental health treatment. They also help some mental health clinicians obtain jobs in the field, which helps
match supply and demand in a way that is a benefit to society.

But despite certain advantages offered, pressure within these companies to increase profitability for their investors is at odds with quality patient care and I predict we will see more negative press with these companies in 2023. Why?

In private group discussions on social media among therapists, psychologists, and psychiatrists, there are more frequent aspersions about their various unethical business practices, such as selling patient information to business partners, recruiting tactics, and perfunctory prescribing of controlled substances. The negative reputation among mental health professionals will lead to increased turnover at these businesses and overall worsen patient care.

One mental health clinician stated in a group message, regarding the selling of patient data from a VC-backed app that shall remain nameless, “the rep I spoke with who was trying to encourage me to work with them told me that this is how they make their money. I asked how, if they paid therapists 100% of insurance reimbursement, do they stay in business, and she said that the volume of client data they have access to is valuable to insurance companies and other stakeholders. They aggregate the data and provide to these entities for a fee.” This claim is consistent with this company’s privacy policy that states they may sell consumer data to business partners.

The average consumer is becoming better informed when assessing the landscape of treatment options. Consumers are more savvy when reading reviews and trying to find best recommendations for therapy. A quick google search will reveal waves of online chatter about bait-and-switch recruitment practices and therapists who feel they are risking their licenses to remain in compliance with corporate strategies.

Here are some problems with treating mental health therapy as a tech investment:

• Privacy policies for VC-backed firms reveal they share personal information with insurance companies and “business partners” which can include a multitude of companies.
• VC-backed mental health platforms are incentivized to keep patients in therapy and normalize the concept of life-long therapy.  
• VC-backed prescribers and therapists are pressured to maintain high patient loads, which draws focus away from quality improvement, education and evidence-based approaches.
• Low employee satisfaction with this profit-driven business model leads to high attrition rates and in turn, poor-quality care.  

Indeed, there are advantages to normalizing the seeking of mental health treatment, but one must wonder if these business practices will lead to increased regulation of this space and an overall negative impact on the field.

Psychedelic-Assisted Therapy

Previously considered a fringe treatment option, psychedelic-assisted therapy is becoming much more commonly sought and will become more mainstream in 2023. Psychedelic experiences are being discussed on podcasts and eye-catching documentaries on Netflix, fueling the hype. Public consensus of acceptance of such alternative treatment options is also driving much needed research studies on effectiveness. Psychedelics, such as ketamine, MDMA, psilocybin, and ibogaine have now burst onto the scene and into our conscious awareness.  

Psychedelic-assisted psychotherapy (PAP) involves the use of a small amount of a hallucinogen to facilitate the creation of a mindset of unparalleled openness to alternative perspectives on long-held beliefs, and an actual biologic creation of new neuronal pathways. PAP is most commonly used with the treatment of PTSD but is also studied and used clinically for treatment resistant depression, OCD and certain addiction disorders.  

In 2022 there were 41 search results on PubMed pertaining to PAP, whereas in 2019 there were just 8. More research studies showing effectiveness on par with, or exceeding, traditional therapies combined with the public demand will make PAP a trend to watch in 2023.

Summary

Of course, as with most problems we encounter, many are turning toward digital tools for a solution. While telehealth exploded in popularity in 2022 due to the pandemic, I do expect that these modalities of care that involve human interaction will continue to rise, such as EMDR,
psychedelic assisted therapy, and virtual reality. I believe that the trend on social media toward transparency and closeness will yield an overall net draw away from “hands-off” mental health apps. I also think that VC-backed mental health giants will start to lose their luster (although this may be offset by aggressive marketing campaigns), prompting spinoffs of “small feeling” services that focus more on engagement and interactions. Get ready for an exciting year to come!