Nuggets #18: Nothing changes

It's been a while. "Don't call it a comeback", etc., as this may be a one-off depending on how long it takes to write.

One realisation from the past year is that AI has yet to improve at writing this newsletter style, and maybe that's a good thing anyway. The first attempt at this one was made in Google Gemini, and if anyone's interested in how bad it was to wrap my particular tone of voice around some research notes, I'll happily share it.

It's been nearly a year since I wrote one of these, and frankly, very little has changed in the health space in between. It shows how long these products take to craft, test, improve and approve - indeed, I know of one pioneering app that might not make it to market after 7 years of messing around by the NHS. It shows how many hard-working people persist in a tricky, regulated, unforgiving landscape with very little human or financial capital at their disposal.

Others are getting there - the good people at Holly Health who had various mentions on here over time, being named "Best mHealth App" at a recent award ceremony for one. The equally good people at Luna go from strength to strength with their teenage mental wellbeing app, taking a top-5 spot at Techcrunch Disrupt recently. Having been at that event and seen the dozens (sometimes over a hundred) pitches that pass through, it's no mean feat. Although the one time I did sit and listen through them, a pretty anxious young lady got the silent treatment from a tech-bro audience with "Hack my Mood" doing something along the same lines. Times change. Look at the presentation below and the thoughts of founders?Jas?and?Jo.

More power to those people as they try hard to lighten the load on a completely exhausted UK health system. The nation's health and public finances depend on many companies surviving and becoming part of primary care and preventative medicine.

A couple of things jumped out this past year, though. Various family medical issues gave us an insight into how stretched the system is; when you have to call 111 and are met with "you might want to find the nearest defibrillator in case it's a while", you wonder what's going on. The fact that defibrillators are mapped and catalogued for the 111 call handlers is scant consolation.

Then, when you realise the waiting list for a particular child diagnosis is a minimum of 3-6 months, depending on your postcode, and that the interim is "keep calling 111 if you need to", you're probably going to do something else. Then you realise that if you have ￡1,000 and enough spare time to phone around private hospitals, you can get it done in about five days.

Then further, when part of the aftermath is teenage self-help, and most of the guidance is delivered via paper leaflets you generally see strewn on the coffee tables of outpatient waiting rooms, you can see many gaps in the market. Teenagers are going to pay little attention to those. And when you help deal with apps for teenagers and realise how bloody hard it is to get the NHS to adopt a digital product instead, you realise why.

Back in March I wrote a short post for Waracle about the rise of digital mental health aids.

The post had good intentions and was intended as a summary of the current market, but in hindsight, one particular section stood out, referring to Replika and its increasingly popular AI-enhanced mental health app:

Replika divides opinions as to whether this is a genuine mental health tool. In a society where we have become increasingly isolated, it may be the case that a digital companion is a preventative measure for offsetting conditions such as depression.

But then pertinently, and incredibly sadly, this was in the news recently:

Opinions may have been divided in March on using automated or even LLM-enhanced products to cater to emotional and mental wellness support, but they are certainly divided now. One community in which I participate has long debated using voice services in this particular world. Still, it's a non-starter for now, particularly with Amazon?needing help to get its new, more conversational Alexa platform off the starting blocks. When you spot Amazon allowing things like this in its Alexa Stills "store," you wonder how much oversight the platforms have.

(Believe it or not, this is a service offering trivia about suicide rates and methods).

However, about five days after my Waracle post was published, I switched from analyst to customer for these services.

Burnout is real; you know it's there, and you know it's getting worse, but unless you arrest it, it just spirals. I know people who ended up in hospital over it and didn't want to become another one. So, on April 1st, with the very kind support of various people (they know who they are), it was time to shut everything out and start the repairs.

For a while before that, I'd been in the care of a nice therapist on?BetterHelp, but in truth, a weekly chat, the odd book recommendation, and being told, "Why not do something about it?" wasn't helping an awful lot for upwards of ￡200 a month.

So what then? With the very lucky benefit of workplace wellbeing schemes, a self-referral to Headspace was undoubtedly worth a go. Given my curiosity for data-driven health services and wearing a?Whoop?band, which integrated directly into Headspace activities, off we went. As it turns out, meditation is only for some, and even after 2 months, it was raising the heart rate by about 20% with no obvious benefit otherwise.

So, in parallel, it was time to try some community-based therapy via Togetherall (formerly Big White Wall), which aims to be a scalable service, presumably funded by these wellness platforms and health insurers as a light-touch early intervention.

Togetherall is a peer-to-peer mental health support community which is available online, 24/7, and is completely anonymous so you can express yourself freely and openly. Licensed and registered mental health practitioners, called Wall Guides, monitor the community to ensure the safety and anonymity of all members.

The reviews weren't encouraging, though:

So, having posted anonymously about what I thought were the root causes of that particular period, the "Wall Guide" opened it up to the community, who mostly responded with "Is that it?" - and I guess that's a bit of a reset which makes you think how bad things are. Still, at the same time, it's hardly a wellness service. At best, it was a way to let off some steam safely.

Everyone will have a different experience with these platforms, so this is not a "review" or a generalisation. However, given the private nature of these things, you can only describe your own experience.

We looked at a few of these platforms at Waracle in the past and ultimately believed that the litmus test is "Would you pay for it if your employer didn't?". So far, 0/2.

So then it was time for actual clinical help. Once again, you realise how stretched the system is; relying on the NHS could see 18 months before you make much progress. However, even the private sector took weeks and many rejections to find a clinic with both the capacity and the speciality. It's also amazing how hard it is to seek these services - maybe supply constraints dictate that there's no need to have something in the middle just yet (let's not call it the "Uber for therapy"). However, there has to be an easier way than Googling and navigating past its irrelevant Dr Google paid and boosted listings.

There's a whole extra blog someday about Neurofeedback therapy and the impact it eventually had. However, it's surely a candidate for self-help one day with the right level of onboarding and safeguarding, but you can do your reading and read between some lines there. It appears to work.

But it firmly put me off thinking about services like Woebot, Replika or any other semi-automated wellness service. And Headspace can get in the bin.

One thing that gave me great benefits was ditching LinkedIn for a while - thanks to its "hibernation" mode. This post might get banned for saying it, but some of the cycles of bullshit and spam that keep this platform's metrics spinning are worth avoiding.

Someone once said that LinkedIn had an obvious product flywheel. Daily nosiness leads to irregular research, which sometimes means building up your network, eventually leading you to your next job. A 1-4 continuous product cycle which, for a cohort of people spinning it, generated $26 billion for the founders. And yet, for those who treat it as a way to keep in touch and broadcast the odd work-related thought, it's like the jungle. It can even be poisonous for those who too quickly get drawn into doomscrolling and the downward cycles it can cause. I've been surprised at how many people have turned out to have done the same.

And I'd forgotten how LinkedIn banned me for 2 weeks for daring to reduce my network to people I actually knew!

In anticipation of writing one of these newsletters again, I contacted my pal Linda Barclay Isles who had starred in January's last edition, to see if anything had changed in the world of femtech.

Apparently not, given the article Linda shared for research:

There are some startling things in that article, but the one jumping out was this quote:

Even women-focused grants are underdelivering. In September, Innovate UK was forced to apologise after it awarded just half of the 50 promised Women in Innovation awards, each worth ￡75,000 to female founders, in what it dismissed as a budgeting mistake.

When the poster child of the space, Flo Health, is seen to have got its most recent $200m funding round because of male representation on its board, there's something fundamentally wrong.

This issue will be around for a long time, so I'll do more digging for another newsletter dedicated to the topic.

For ongoing actual nuggets about digital healthcare, please remember to follow the HealthTech Roundup for much more.

Small print: This newsletter goes out to subscribers and across LinkedIn irregularly after a weekly run of articles in 2023. Feel free to contact me if you've seen or are creating something interesting in digital health, specifically mental health or femtech issues. I currently work for Waracle and may share the odd update on their work, but all opinions and content selections are my own. Anything in which I have a business or personal interest will be declared.

In this newsletter, I mentioned Luna, where I have a non-material crowdfund stake.

Cover image by DALL-E via LinkedIn. The prompt was "a blog post about burnout".

And yes, Billy Ray Cyrus > LL Cool J.