Dr. Nick Allen of Ksana: “We need to increase assess to mental health care without losing quality”

We need to increase assess to mental health care without losing quality. Although Digital approaches to mental health are great for increasing access, many do not provide high quality health care (especially some of the stand-alone apps). We need to make sure that what we are offering really is effective before we scale it up […]

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We need to increase assess to mental health care without losing quality. Although Digital approaches to mental health are great for increasing access, many do not provide high quality health care (especially some of the stand-alone apps). We need to make sure that what we are offering really is effective before we scale it up and pretend, we have solved the problem when people may only be getting more access to things that don’t work.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Dr. Nick Allen of Ksana Health.

Dr. Nick Allen co-founded Ksana Health in 2019 to translate the tools and technologies he developed as the Director of University of Oregon’s Center for Digital Mental Health into products and services that will transform mental health care and research. Dr. Allen is a clinical psychologist and social neuroscientist who investigates the interaction between biological, psychological, and environmental risk factors during adolescent development in order to more fully understand how to prevent mental health problems and encourage healthy development during this critical stage of life. His 30+ years of experience in clinical psychology, social neuroscience, research and education led him to develop two platforms available through Ksana Health.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

I am a clinical psychologist who has been working in the area of youth mental health my entire career. I have been doing research on the causes, prevention, and treatment of depression, anxiety, and substance use problems in young people for over 30 years. About 8 years ago I started looking into how digital technology, especially smart phones, could be used to solve some of the long-standing problems we are facing with how we help people experiencing mental health challenges. As a result of this, after many years as a health care practitioners, researcher, and professor I became convinced that the best way to have an impact was to start a company focusing on digitally transforming mental health services. I am now the Co-Founder and CEO of Ksana Health, whose mission is to use research evidence and modern technology to revolutionize the delivery of mental health care through objective measurement and personalized intervention.

Can you share the most interesting story that happened to you since you began your career?

I met my wife at a professional conference, so that was life changing! In many ways I think starting the company is the most interesting story of my career. I never thought I would do anything other than be a psychologist and a professor, so starting a business was entirely unexpected. The interesting thing is that my goals have not changed, just the means for getting there. I think the lesson is that you have to be ready to pivot and move in unexpected directions even if you are pursuing the same goal. Life can be much more interesting when you continuously set yourself new challenges and stretch outside your comfort zone.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

Once I was on a train heading out to rural town to do clinical work all day. My trousers caught on a nail and ripped right down the leg. I managed to make it through the day seeing a whole list of patients with my leg exposed. What I learned was that despite the fact that I thought this would be a huge issue, almost no-one cared. People pretty much only cared about whether I was going to help them. So, I guess I learned (again) that I was not the center of the universe and other people had better things to worry about then whether my trousers were ripped. Of course, these days it might even be considered fashionable!

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

I love this quote from Mark Twain: “I am an old man and have known a great many troubles, but most of them never happened.” As someone who tends to worry, that quote has always helped me have a sense of perspective and helps me to focus on the real challenges, rather than the imagined ones.

Are you working on any exciting new projects now? How do you think that will help people?

Yes, we are launching our new digital mental health platform, Vira. The Vira mobile app for iOS and Android helps people access the right level of mental health care easily when they need it. Vira uses the sensors in your smartphone to automatically collect objective data on behavior to provide personal insights into the habits that shape each individual’s mood. Vira helps to improve people’s self-care by providing insight into which of these daily habits and activities help you feel like your best self, improving your overall mood and sense of accomplishment. The system can also help improve your experience in therapy by connecting you with your practitioner between appointments. Your therapist can use the information that you share with them to get more insight into how you are progressing between appointments and can build a therapy plan that is tailored to your unique needs and better support you in achieving your mental health goals with just-in-time reminder (“nudges”) that remind you to follow through on these commitments.

How would you define an “excellent healthcare provider”?

An excellent health provider provides access to high quality, effective health care to all those to who need it, irrespective of their personal geographic, demographic, or financial circumstances.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

Obviously one of the biggest issues in health care are the social inequalities regarding who gets access to healthcare, and especially who gets access to the best quality health care. During the pandemic we have seen these long-standing issues made worse, with marginalized communities (e.g., people of color, LGBTQ individuals, the economically disadvantaged, people in rural areas) being much more likely to contract COVID, and to experience severe illness or death when they do contract it. In short, the pandemic has laid bare the ways that our current system does not get resources to those who need them most. We need to modernize the system so that factors like geography, racial background, and financial circumstances no longer determine who gets the best care. The good news is that we already have many of the tools we need to modernize how the system is administered and funded so we can start to overcome these issues.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

I guess the biggest change was that almost all mental health care moved from in-person to Telehealth overnight. We also saw changes in regulations and laws to support this — probably 10 years of change in a couple of months. This means that almost all practitioners and their patients can now use Telehealth to get and deliver services — something that could dramatically increase access and convenience for patients. Although a lot of mental health care will move back to in-person after the pandemic subsides, having the Telehealth option will be a big improvement for many people. This move to Telehealth has improved access, but we now need to make sure that the quality of the care is not reduced.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

  1. We need to have parity between mental health care and physical health care. For too long mental health care has only been provided in response to a crisis, and the idea of doing preventative care (e.g., like a regular mental health checkup) has been ignored. This needs to change, especially given the massive adjustments and loss people have experienced during the pandemic.
  2. We need to increase assess to mental health care without losing quality. Although Digital approaches to mental health are great for increasing access, many do not provide high quality health care (especially some of the stand-alone apps). We need to make sure that what we are offering really is effective before we scale it up and pretend, we have solved the problem when people may only be getting more access to things that don’t work.
  3. We need to deliver health care in a way that meets people where they are. One thing the pandemic has told us is that you don’t always need to go to a hospital or a clinic to get the help you need. People are used to services that go with them wherever they are (like the fact that they can order a book online from their phone immediately when someone recommends it for example). Likewise, people want healthcare that is not stuck in the office but is available in their pocket. Our Vira platform is designed to achieve just that.
  4. Health care needs to be more personalized. Mental health is unique to each individual, so mental health care should be tailored to the individual too. We designed our Vira platform to help people get support that fits with their current needs, based on their unique behavioral patterns. Vira is designed to learn what behaviors give you the greatest sense of enjoyment and growth, rather than comparing your unique needs to averages or generalizations.
  5. Health care systems need to systematically collect data on the local communities that they serve, so that they can learn quickly what works in their specific context and with the specific patients they serve. Although health care does collect a lot of data, most of it is stuck in records and files that are not easily accessible, so its very had to use the data to learn these things, let alone being able to do this in real time. However other industries have gone through a digital transformation where data is made more transparent and useful, and this is clearly needed in. Healthcare. Digitizing health care data will also result in much more rapid learning, but it must be done with very high standards of privacy and security.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

Health care is inefficient, especially mental health care. We need to use our highly trained psychologists and psychiatrists to do what they do best (and what they enjoy), which is helping patients. However, we ask these practitioners to do a whole range of things that are not best using their skills and can often be automated or completed by others in the system with different levels of training. This is where digital technology can make a huge contribution. As it has in other industries, digital approaches can be used to organize and present data in ways that help the humans in the system to make better decisions and allow them to spend more time using their highest (and most human) clinical skills, rather than getting burned out on administrative tasks. An example of this is how we use Vira to automate writing clinical notes, something that practitioners spend a lot of time doing and that is known to lead to burn out.

How do you think we can address the issue of physician diversity?

This, of course, is a long-standing problem that requires multiple strategies to address it. A good start is to ensure we have diversity in those seeking and receiving training in health care, especially amongst those who will have leadership roles in the future. We need to stop seeing clinical training as a privilege for those who are most advantaged or can perform well on the kinds of tests that get you into medical or graduate school (which of course is not the same as true intelligence.) A health care system that serves diverse communities must have diverse professionals within it, and importantly we need to make sure that those diverse individuals are involved at all levels of the system.

How do you think we can address the issue of physician burnout?

Reduce caseloads, but more importantly, understand what aspects of the job cause the stress that leads to burnout. Many people would be surprised to know that it’s not usually the health care part of the job that cases stress, but rather the organizational context and that fact that clinicians have to spend a lot of their time on non-clinical activities. We can support physicians and other clinicians to spend more time doing what they love and what they are goblets at, then burnout would likely reduce.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

We have to stop telling ourselves we have great healthcare because more well-off Americans receive great healthcare. Rather we need to ask what kind of health care system we have. For example, does our system get the resources to those who need it most? Is it efficient, so that extra resources can be directed to those in more need? Does it provide good access, high quality, and effectiveness for everyone? Does it prioritize prevention as well as treatment? When we can answer “yes” to these questions we will know we have the kind of system we want and deserve

How can our readers further follow your work online?

Visit my company, Ksana Health at www.ksanahealth.com

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.

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