Solving burnout via self-help

A case study on the mental self-help approach for patient empowerment, creating health equity, and improving clinician outcomes. Based on a presentation held on June 14th at HIMSS Helsinki.

We are living in a Global Mental Health Crisis.

Some pre-COVID factors

• A long-overdue need to re-imagine mental health as a whole. Improve diagnostics, and implement biomarkers and behavioral data. Shift from eminence to evidence-based care.
• A dysfunctional educational system - only a small share of all mental health experts receive the needed education, supervised training, and toolset for handling Serious Mental Illness, Md, I. T. (2022).
• A dysfunctional path to finding the right expert, at the right time, at a bearable cost.

All of the above meant it was challenging, to say the least, to find the right expert on time. As if it was not enough, COVID-19 came about. The already weak system for mental health received a hit. Nearly all established social norms were put to the test. A flood of constant negative news, social distancing, work from home and cutting back on most of our favorite recreational activities. And this is far from an exhaustive list.

All of the above led to a multitude of developments, including The Great Resignation, political instability, and various behavioral changes. All areas of mental health are impacted and we are currently only at the very beginning of the shift. The thesis does not account for the war in Ukraine and its expected consequences on global mental health.

Problem(s)

In 2021 50% of the global working-age population was at risk of burnout. (Agrawal, 2022), (Statista, 2022)

Self-help

"Self-help" has been around for a while and promises to take on an ever more crucial role. How to supply individuals with trustworthy information, the right tools, and a call to action for the next steps? Which area(s) can be covered by self-help and when do we introduce a specialist? Some well-functioning examples include HelloBetter, Selfapy, and Meru Health, complemented by the newcomers such as Digiburn.

What can we improve?

1) Awareness. Burnout, just as anything else with mental health, is wrapped in mist. Let's debunk stigma, create safe spaces, and emit trustworthy, reliable information. Combine scientific and practical to speak at eye level with the patient.

2) Trust. Ensure the individual has access to all relevant resources on the topic without fear of adverse effects from the employer or insurer.

3) Empower. Put the user in the driving seat. Create a delightful process, motivate for first preventive steps, recognize potential warning signs, and take action early on. Prof. Dr. K.K. (2018)

4) Place, time, format. Cater to the needs of the specific audience.

5) Ethics. Define the self-help boundaries, and communicate clearly from which point onwards work with an expert may be advised.

Assessment/Intervention

In contrast to any other healthcare area, mental health has not yet made the swing towards wide-scale inclusion of health and behavioral data or incorporating effectively contextual and temporal aspects. Despite technological advancements, mental health is still largely in the Stone Age.

There is no X-Ray for mental health in wide adoption yet.

Some contributors

Burnout is still classified as an "occupational phenomenon", (Burn-out an “Occupational Phenomenon”: International Classification of Diseases, 2019)

While there is nothing wrong with the depiction, it leads to a few challenges:

• Burnout is indeed mostly known for its occupational character, yet this is only one subtype of the syndrome. One can burn out in many other areas, incl. personal, intimate, etc. On the same theme, the 3 listed dimensions are by far not exhaustive for a vast array of indicators and drivers for burning out.
• Not recognized as a medical condition means there is no established clinical pathway. Specific steps and outcomes depend entirely on the specialist.
• Being merely an "occupational phenomenon" makes it challenging to speak about behavioral data, biomarkers, or comorbidities.
• Not being recognized as a medical condition means greater uncertainty for solution providers to work in the field.

Engagement

In post-COVID times we have an array of mental health solutions, telemedicine, digital therapeutics, and metaverse. Yet how do we truly engage with patients and physicians?

• How do we create truly immersive clinical paths, with the patient in the driving seat?
• How do we move from the label user/client to patient??
• How do we drive awareness-backed, bite-sized daily engagement??
• How do we meet people at the right place, at the right time, and with the right offering? Md, I. T. (2022). The model of waiting for the patient to come to is up for re-thinking.
• How do we leverage technology and the existing ocean of data points for a cohesive, immersive experience, such that the patient loves from the first sight?
• What user-experience tricks can we take away from tech leaders (Apple, Amazon, Deliveroo, Google, UPS, etc.) and implement for better, outcome-driven healthcare?
• Having tackled some of the above, how do we move towards proactive healthcare and incentivize being healthy instead of covering expenditure in sickness? Prof. Dr. K.K. (2018)

Better outcomes & health equity via 100% self-help

Having explored some challenges, let's have a quick future outlook.

• Anonymous, on-demand, global, equitable.?Debunk stigma, and improve access. Create safe spaces for immediate information access, assessment, and self-help. Improve health equity and cater also to underserved populations and social layers.
• Digital phenotyping. Behavior is temporal and contextual. Let's introduce biomarkers and behavioral data. Tailor the journey to the specific needs of the individual - content, extent, timing, etc. Integrate existing data agnostically. Re-frame and re-contextualize to make it meaningful and actionable. Establish the fundament for the future of digital phenotyping, transforming the patient's journey from eminence to evidence-driven. Establish a clear clinical path. Move both assessment and intervention much earlier in the patient journey.
• Personalized, holistic, end-to-end. The existing patient journeys in mental health are fragmented and have dead-ends, loopholes, question marks, and dependency on luck. Drive personal awareness and responsibility by creating end-to-end, closed-loop journeys - risk assessment, self-help, and follow-on support. Act holistically, and personalized, catering to the specific characteristics of the given cohort. Inspire deep engagement at every step of the journey. Keep adding value along the way, building trust, emotional connection, and desire to adhere. Utilize bite-size approach & feedback loops.

Engaging Users 360

Patient engagement is a game-changer.

Knowing something and not doing anything with the knowledge is equal to not knowing it in the first place. Similarly, even the best intended and well-structured therapy is only worth as much as it manages to reach, attract and retain the patient for good.

The user journey revolves around "reach", "attract", "retain", and "repeat".

Start each stage start by answering:

• What is the value-add for the patient at this touchpoint? An engaging journey adds value at every step.
• Do we engage in the best-suited way for the patient?
• What uncertainties may the patient have?
• How do we keep on building trust?
• How do we promote awareness-baked action?

Reach

The user may or may not yet be aware of the personal need. Show empathy, and understanding, and be clear with Your intent.

• Why – understand the user challenges at the specific phase of the syndrome.
• Where, when - be there for the users at the right place and time. Be mindful of existing habits and patterns for dealing with adverse circumstances.
• What – answer common questions before even receiving them.?

Attract

Some initial patient awareness of the personal need. Start building trust and expectations.

• Keep on adding value. As above, an engaging journey adds value at every step.
• Offer a low-risk entry. Understand and address uncertainties early.
• Bite-sized steps. Engage one step at a time. Even a journey of 1.000 miles begins with a single first step.

Retain

• Establish radical ownership of the patient's needs across the continuum.
• Follow the paradigm of a regular, bite-sized, two-way exchange.
• Ensure momentum at every step, starting with the very first interaction.
• Carefully navigate complexity in line with the patient's progress and needs.
• Understand well the different cohorts, serve accordingly.
• Use the feedback mechanism for deserved rewards along the way.
• Find out who the power users are, give them the opportunity to shine.
• Create a safe-community-environment - combining the need for connection, while maintaining the desired degree of anonymity

Repeat

Keep reverting to the reach step, even post-onboarding. Iteratively cycle between all 3 stages. Revisit Your guiding questions for a continuous value-add, aligned to the progress and evolving needs of the patient.

Engaging clinicians

Start by answering “Which are the shortcomings of the current clinical path? How can we support clinicians for a better outcome?” It is an iterative process, revisit regularly.

Designed together with psychologists

Clinician engagement comes through patient engagement. It is a function of notably improving patient outcomes, reducing friction, and keeping the clinician in the loop from the very beginning.

• Deep dive and understand profoundly the current best practice. Analyze, tinker, and ultimately forget everything completely. Start a-fresh. Crucial for thinking out of the box. Start on a blank sheet of paper, and aim for the sky, instead of incremental improvements.
• Regularly check in with the experts. This brings healthy skepticism, and fresh perspectives and helps address blind spots.
• Involve other stakeholders too. E.g. the spouse/partner, the manager, the business partner, leadership, direct reports, personal social circle, the fitness trainer, etc. Get a holistic view of everything happening around the individual, and behavioral changes, and understand opportunities for intervention.

Improve experts' reach & outcomes

• Empower experts to cater to otherwise not-obtainable inquiries - out of reach, out of scope, or involving long waiting times.
• Act complimentary. Be the missing tool for proactiveness. Cover basic topics outside of therapy. Build awareness, and educate the patient along the journey, before the conventional therapy has started. Improve adherence and allow the patient to act as a co-creator, rather than merely a participant.

Cater to limitations of conventional therapy outcomes

• Drive involvement & ownership by putting the patient into the driver’s seat. Build the idea of personal participation and results tracking. Entitle the patient to the Chief Quality Assurance Officer.?
• Increase clinician engagement by engaging the patient. Pre-therapy activities, in-between session engagement, tangible progress feedback.?
• Complement with behavior-building component and progress monitoring.?

Closing remarks

Hope You found some value in the article. It is merely a high-level depiction of a future vision. Take with a grain of salt, feel free to disagree, comment, or otherwise let us know Your thoughts. We are only humans and act according to our best possible knowledge and skills at any given moment in time.

We truly believe in the merits of collaboration, idea exchange, and the need for many more players across the field to unite around a shared vision for the sake of Global Mental Wellness. As there are no 2 identical human beings, so there is no one-size-fits-all approach. The more and better solutions out there, the better chances of getting out of the Mental Health Crisis on good foot.

Digiburn

A burnout risk-assessment tool and 12 weeks self-growth journey, 100% self-help, anonymous, and conveniently available at the place and time of Your desire. Get Digiburn on Apple App Store and Google Play.

We are currently looking for pilot partners and particularly innovative companies, interested in collaborating, innovating and ultimately empowering their own talents for finding better ways towards a more fulfilling way of living. If interested, get in touch at [email protected]

Useful Digiburn links

P.S. Here we are with Megan and Laura just before going on stage to discuss "Advancing Digital Therapeutics in Mental Health: Improving Lives and Tackling Inequalities", June 14th, HIMSS Helsinki. While we can speak on serious topics, we are all just humans, happily enjoying the process and exciting journey each one of us is going through. Take care.

Disclaimer?All of the above represents a subjective opinion. The content has been written with the intention of idea sharing and discussion. The content has not been reviewed or endorsed by any of the parties mentioned. The views and opinions expressed do not necessarily represent any policy or position of HIMSS. In case of any objections, false claims, or otherwise editorial needs, please feel free to contact me via DM on LinkedIn or in the comment section below.?

Digiburn is not a replacement for professional help. Mental self-help apps are not a substitution for therapy. Please consider visiting your house doctor or reaching out to a mental health expert.

References

Agrawal, B. B. W. A. S. (2022, June 10). Employee Burnout, Part 1: The 5 Main Causes. Gallup.Com. https://www.gallup.com/workplace/237059/employee-burnout-part-main-causes.aspx

Burn-out an “occupational phenomenon”: International Classification of Diseases. (2019, May 28). WHO. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

Md, I. T. (2022). Healing: Our Path from Mental Illness to Mental Health. Penguin Press.

Prof. Dr. K.K. (2018). Your Guide to Delight. Skribis - Mirto Print

Santomauro, D. F., Mantilla Herrera, A. M., Shadid, J., Zheng, P., Ashbaugh, C., Pigott, D. M., Abbafati, C., Adolph, C., Amlag, J. O., Aravkin, A. Y., Bang-Jensen, B. L., Bertolacci, G. J., Bloom, S. S., Castellano, R., Castro, E., Chakrabarti, S., Chattopadhyay, J., Cogen, R. M., Collins, J. K., . . . Ferrari, A. J. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet, 398(10312), 1700–1712. https://doi.org/10.1016/s0140-6736(21)02143-7

Statista. (2021, January 18). COVID-19 pandemic impact on metal health in Europe 2020, by country. https://www.statista.com/statistics/1196014/impact-of-covid-19-on-mental-health-in-europe/

Statista. (2022, May 31). People who experienced or were close to burnout in European countries in 2021. https://www.statista.com/statistics/1249649/experiences-of-burnout-in-europe/

Williams, C. (2021, February 3). Pandemic burnout: Do you have it and what can you do about it? New Scientist. https://www.newscientist.com/article/mg24933202-400-pandemic-burnout-do-you-have-it-and-what-can-you-do-about-it/

Women in the Workplace 2021, McKinsey & Company, Lean IN https://womenintheworkplace.com/

Credits

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