2020 has been a challenging year in many ways, including for everyone’s mental health. The COVID-19 pandemic has caused a spike in mental health problems with cases tripling in the number of adults experiencing depression. Existing sentiments and situations drag on now into 2021. Today, the mental health care system is not very efficient and in many cases, broken, due to a shortage of access for patients and a lack of lasting results. Following the increasing mental health problem trends, a study published in JAMA Network Open in September 2020 offered one of the first nationally representative estimates of how severe this epidemic may be: three times as many Americans met criteria for a depression diagnosis during the pandemic than before it. Fortunately, the pandemic has also put an emphasis on telehealth and a larger focus on general well-being innovations. Meru Health is setting a new standard in mental healthcare with one of the most comprehensive online solutions, which combines licensed therapists and psychiatrists, a smartphone-based treatment program, a biofeedback wearable, and anonymous peer-support groups. Meru’s innovation is important in that it offers a more holistic treatment regimen that aims to help people develop better coping mechanisms, habits, and skills through increased self-awareness of their overall emotional and physical health. Instead of prescribing medications, Meru aims to target the root causes of mental health issues and, importantly, addresses the issues of community and intense feelings of isolation and loneliness. Trends targeted by CEO, Kristian Ranta, for 2021 include: Scaling telehealth solutions for mental health. Telehealth is seen in some way as a solution to all of our mental health problems. But the problem of enough access to providers didn’t really disappear. One provider can only treat some 5–8 patients every day, so there ultimately isn’t enough providers to treat everyone in need. As mental health gets more and more attention in 2021, there will be more efforts toward scaling therapists, as the massive provider shortage will unfold. Evidence-based care is becoming increasingly important. There are many articles about new apps or digital treatments to cure our minds but 99% lack any scientific data. What will be important in 2021 and the following years is scientific data that demonstrates how these new solutions really show effectiveness and long-lasting results. Focus on suicide prevention. This is a growing problem that is getting more and more attention as the suicide rate keeps rising among young Americans. Companies and insurance providers are addressing this issue for their employees and members; businesses like CVS Health have stepped up with resources and support to combat the rising rates of suicide, and we expect to see more of these types of programs rolling out in the coming year from companies who are proactive and paying attention to the mental well being of their employees. Mental health aftermath of COVID-19. It has been a traumatic time for many – individuals will need help coping with the after-effects such as loss of loved ones, stress from loss of income, separation from friends and family, fear of getting ill, and how to reacclimate once restrictions are lifted. According to a WHO survey, the COVID-19 pandemic has disrupted or halted critical mental health services in 93% of countries worldwide while the demand for mental health is increasing. 2021 will be a year focused on healing and dealing with the pent up demand for mental health services. New and alternative treatments will be explored. The funding for mental health startups has skyrocketed and the alternative methods are taking their share. There have also been a few large studies published this year on their effects, and legislation for drugs like cannabis as medicine is changing. As the therapist scalability problem is being acknowledged, the search for alternative methods that could save our mentally struggling population is growing. We had a chance to discuss Meru Health’s offerings with its CEO, Kristian Ranta. Alice Ferng, Medgadget: Tell me about yourself and what led you to start Meru Health? Mr. Kristian Ranta, CEO and Founder of Meru Health: I’m Kristian, the CEO and Founder of Meru Health, with Meru being my third healthcare business. I founded Meru Health in 2016 with my co-founders Riku Lindholm and Albert Nazander. There were two personal reasons for founding Meru: one was that I unfortunately lost my brother, Peter, to suicide because of his depression, and then the second reason was that I am a computer science and information systems geek or nerd. And I’ve always been fascinated about how to improve healthcare with information technology. So those were the motivations for myself and I wanted to dive into mental health to help other people, you know, be better, get better, stay better, and not end up like my brother. I wanted to change how the system works, because it’s one of the one of the most inefficient systems in healthcare. Medgadget: That’s really powerful – and I’m sorry for your loss. Mental health is an incredibly important topic. I’d love to hear more about Meru’s innovations and platform. What makes Meru unique and different from a service such as Talkspace? And out of curiosity, what were your other two healthcare businesses? Mr. Ranta: The other two were diabetes businesses – one was a medical device business that was a glucose monitoring business sold to Korea back in 2015, and then the other business was a diabetes population management software system for diabetes, diabetics, or people with diabetes, to help connect them with their doctors and nurses. A kind of a care team for diabetes, which was a spinoff from my first company. So yeah, a couple of the main points that I always talk about are the things that are broken in mental healthcare: access – it’s really hard to get access to care. And then the other thing is that if, you know, we had great results with the care we provide today then we would only have maybe half the number of patients trying to get access. So the other challenge is that the results are not particularly good, or at least not long lasting for depression or mental health treatment. And that’s another major problem. We founded Meru to solve the access problem, to help people by using digital tools and so forth to get instant access to care that is effective. And what I mean by effective is that typically, 1 out of 3 people suffering from depression, as an example, will get better in the first 3 to 6 months from when they start treatment. 1 out of 3 doesn’t sound that great. And why is that? It’s because today’s psychiatry is using kind of a shotgun approach, just throwing at people a couple of modalities: antidepressants – most of the times as the first line of care – and then some other therapies. But the challenge is that there aren’t enough resources in the market to actually provide people with a comprehensive therapy. The average length of a therapy session or therapist relationship in the United States is 1.5 therapist sessions. And if you look at the antidepressant side – 80% of people who go to their primary care doctor because of mental health challenges get up-sold prescriptions of antidepressants. Nothing else is tried first, and then call in 1 or 2 months if it isn’t working for you. So that’s the kind of carpet-bombing approach that’s happening now, and it’s clearly not working. From another perspective, we have roughly 13% of U.S. adults on antidepressants today. If the solutions we’re offering to people were really working, we wouldn’t be at an all-time high regarding the prevalence of depression, which is now – depending on the population – somewhere between 15% to 25%. In the population today, it’s even further accelerated and has become even a bigger problem. So, access is important, but it’s not only about access. It’s also actually about when people are getting care – to give them care that works. So that’s why we built Meru – to be a more holistic platform and to be a more holistic offering. What I mean by that is that we realized from our earlier experiences that mental health is not just about talk therapy, or it’s not just about taking the pill – taking a pill – and then, you know, hoping that it’s the right pill for you, and that it might work for you. It’s about understanding. What’s the role of your sleep? What’s the role of your gut health? What’s the role of your nutrition? How about exercise? It’s been studied and shown that exercise is an important factor. And then we’ve also built-in wearable biofeedback, so there’s a wearable biofeedback device that we ship all of our patients or participants. And that’s a method for people to learn to self-regulate and de-stress through deep breathing because stress is an important mediator in pretty much all mental illnesses. But there are all these factors. To give you another example, sometimes people have a serious vitamin B12 deficiency, or something else that’s purely physiological or biological. It has nothing to do with cognitive behavioral therapy or with antidepressants. And then how could you possibly fix that if you don’t go beyond just talk therapy or antidepressants, and that’s how we see mental health evolving and going forward. We’ve built a specialized clinic, and we’re a provider – so it’s an online virtual clinic with real providers, but we go way beyond just talk therapy. We don’t prescribe medications at all, but we do therapy, and teach people self-regulatory skills and other skills that they can use to become more empowered in taking better care of themselves. And all this has led to us publishing with Harvard, with Stanford, with UC Davis, and with some other universities. And we have another six, seven papers under peer review, from various clinical trials that we’ve conducted. We’ve done single arms, we’ve done randomized control trials, and we’re running several new trials, as of now one with Stanford medicine. There’s one independent study going on. So there’s just a lot of research also, because our approach is very different from, you know, pretty much all of our competitors are CBT, or sometimes CBT, and medication. And so, long story short, that’s how we differentiate. Medgadget: I love the focus on approaching mental health holistically and appreciate that you even mentioned gut health and nutrition, in addition to exercise – all of this can really make an impact but isn’t talked enough about. Forming healthier habits is also incredibly important. I’m curious about the biofeedback wearable device that you send to customers – can you elaborate more on that? Mr. Ranta: So there’s a there’s a monitor that we ship everyone. It’s basically a pulse oximeter and heart rate monitor that connects to the smartphone via Bluetooth. We send people the device in a box with instructions, and the device connects with the Meru app. There’s a breath pacer where people learn to breathe at a certain pace, and there’s heart rate variability (HRV) biofeedback. HRV biofeedback is a well-researched intervention of its own, and as you know, it’s very effective in treating anxiety, PTSD, and also depression. What it basically does is that people, through deep breathing, learn to down regulate their stress response. So they learn to switch from the sympathetic side of their nervous system to the parasympathetic to their recovery mode. So from the stress and activating your fight and flight stress response, you can move someone into recovery mode. Since most people with mental illnesses and mental health challenges are way, way too much on the stress side, this is a very useful skill for people to learn. And when they see the data from the pacer, and then the data that is being collected from the ear clip that’s the heartrate monitor, then people can see instantly their results, and we can guide them through our own data. Taking these deep breaths actually is instantly down regulating your stress response. And then over time, we can kind of show people and their friends how they’re learning more effectively to strengthen the relaxation muscle, if you will. So it’s a reflex in the body, you know, baroreflex, or there’s a couple other other names to it as well. But it’s basically the capability of you regulating your nervous system into the relaxation state. And that then has a lot of positive outcomes. Medgadget: Tell me more about the smartphone-based treatment program vs. having something also on the web and more accessible to that population. You mentioned that you ship these devices to people, including the smartphone – is this for ease of use and also data privacy & security? Mr. Ranta: We validated that device that we use and have partnered with HeartMath. So it’s their device, and we’re not like building our own device since there is already a great company with a great device. We’re just built our own algorithms into our own application for our patients to have a seamless patient experience. And then when they get the device, they get to keep the device and you know, again, like once we have that one single device that we’ve integrated, we know exactly what the patient experience is like, and we can tailor it or make sure that the patient experience, the learning experience is optimal. Because you know, we could also like integrate with other smartwatches and whatnot. But we would never then be able to really control like what’s happening at home when people are practicing. And since we have providers working with every single patient throughout the 12-week intervention, we then also want to make sure that our provider when they work with each of our patients know exactly what’s the device they’re using. So it’s just like making things a lot more simple and then more controllable in that environment, which is the patient’s home. Yeah, that’s a good point about data privacy and security. If we, you know, integrated with other devices, we couldn’t control where the data sits and where the data lies. But in this regard, once we validate a device, and it’s connected to the app recognized by the app, then we can make sure that the data is always stored only in Meru medical records that we built, and is at the core at the core of our clinic. So we have a provider and we have our own therapist using our dashboard that we build for our providers. And then, again, all the devices are linked to our own repository for medical records. So yeah, that’s an important component for us being able to make sure that that the data isn’t lost somewhere. Medgadget: I was very interested when I read about the anonymous peer-support groups – can you talk about that? Who is a part of those groups, how are they formed, and how long would an individual continue to interact with that group? Mr. Ranta: So one of the things in mental health that we learned early on was that people very often, especially with depression, would struggle, kind of feeling that they’re all alone, that they’re isolated. And that was also my brother’s experience to some extent. And we figured that there are great ways for us to kind of pair people with a therapist so that we know we can kind of make sure that that interaction helps people when they’re going through their toughest days or weeks or months in your life. But then the other thing is that it’s immensely helpful for people to see that they’re not the only one, and that similar people like them, are struggling with these similar kinds of problems. And in that sense, we build a peer support group that is kind of led that in a way that people can openly help and advise each other or talk to each other. There’s typically 10 to 20 people when they start the 12-week intervention, but for the program, people are grouped into an anonymous peer support group, where they kind of get to see others as avatars and nicknames. So we keep it private. So people don’t know who you are, but they see avatars and nicknames, and they see their reflections. And they see when these people are all going through the program at the same time. So the curriculum, week by week unfolding, is on the same theme every week. So let’s say that it’s rumination or like worry on one week, then everyone would be kind of like, reflecting on their practices and lessons around worry that week. And then it’s very beneficial for people to see that I’m not the only one who has these issues. I’m not the only one who’s kind of had these experiences. So people not only connect with each other and see that they’re not the only one, but they also learn from other people’s similar experiences. And then the therapist is working with each of these patients separately, and the therapist is also moderating the group and making sure that also these important learnings are shared so that everyone can benefit from that interaction. Medgadget: Thanks for all of your time, attention, and energy invested into this important effort. One last question – is anyone able to sign up for Meru and use it? Mr. Ranta: We are actually currently not fully open to the public because we are available through payers, like Cigna and Humana, but also through like several large employers and some regional health plans. All of the big insurance companies are not yet reimbursing Meru. So, therefore, we have made it available to more closed populations, for now. What we’ve seen in the market is that telehealth has exploded this year because of COVID, because of loosening up some of these regulations that have been hindering the expansion of telehealth in the past. And in the mental health space, we’re seeing a dramatic increase. And we’re also working a lot with health plans. So I mentioned Cigna, Humana, but we’re also almost tied with another national payer. And then we work with several more regional health plans since what we’ve seen during this year has been, you know, a dramatic, dramatic shift in their attitude towards how fast and how widely they want to implement telehealth – also for mental health. Source
