The Intersection of Psychiatry and Technology: Insights and Innovations. Digital Health Interviews: Daniel Lieberman

Hair loss, skin problems, and Viagra. Curious about their connection to HealthTech and technology? Tune in to this episode to get all the details! Don’t forget to subscribe to our channel for essential digital health content. We’re thrilled to introduce our guest for today, Daniel Lieberman, and discuss one of the leading startups addressing mental health issues.

Daniel Lieberman’s Background & Career

Daniel Lieberman, a psychiatrist by profession, pursued his medical education and completed his training at New York University, residing in the vibrant city for eight years. In 1996, he transitioned to George Washington University, where he dedicated 26 years to his professional endeavors. Earlier this year, motivated by a desire for new challenges, Daniel made a significant career move, assuming the role of Senior Vice President of Mental Health for Hims & Hers.

Mental Health in the US

Before speaking about Hims & Hers and Daniel Lieberman’s current role, let’s have a look at the state of mental health in the United States. According to Daniel, the nation is grappling with a mental health pandemic, exacerbated by the profound disruptions caused by the COVID crisis. “People’s lives were turned upside down, they were cut off from their normal forms of support, and everything just became frightening and confusing,” he notes.

Lieberman identifies three key factors contributing to the escalating mental health challenges. Firstly, societal upheavals and changes leave people feeling disoriented. Secondly, the positive trend of destigmatizing mental health illnesses encourages individuals to openly acknowledge and seek help. Lieberman expresses optimism: “Now, we’re not where we need to be yet, but we’re getting there.” Thirdly, the surge in interest in mental health care is hampered by insufficient resources and a broken healthcare system. Lieberman points out the challenges in financing mental health care, citing its exorbitant costs as a major hurdle.

Moreover, he highlights the historical mistreatment of psychiatrists by insurance companies, affecting both the appeal of the field and practitioners’ willingness to work within insurance frameworks. This has resulted in a significant number of psychiatrists not accepting insurance, rendering mental healthcare expensive for individuals who are unable to utilize their employment-based coverage.

In Lieberman’s words, the situation reflects a critical need for reform and increased accessibility in mental health care, addressing both the financial and systemic barriers hindering the well-being of the population.

Suicide Rates and Government Initiatives

“I’ve noticed a significant rise in suicide rates over the past few years. Are there any government initiatives addressing this issue?” our host Alex Koshykov asks.

In response, Daniel expressed skepticism about the effectiveness of government initiatives. “There are initiatives, and in my opinion, they’re largely useless. Educating the public on behavior change doesn’t work,” he states. Drawing a parallel with efforts to combat drug abuse, he points out that spending large sums of money on educating young people about the dangers of drugs has unintended consequences. “Educating children about the dangers of drug use increased the rate because adolescents are stupid,” he quips.

Lieberman emphasizes the power of societal pressure and cultural norms in bringing about behavioral change. Drawing examples from anti-smoking campaigns, he notes that advertisements and warnings did little, while societal disapproval effectively reduced smoking rates. He also highlights the positive impact of private sector initiatives, citing companies like Uber in reducing drunk driving incidents.

Tech’s Role in Mental Health

In addressing the impact of technology on mental health, Daniel Lieberman observes that while the stigma surrounding mental health is diminishing, it will take time for people to feel comfortable seeking help. He emphasizes, “The stigma is decreasing but it’s going to take a long time for that to get internalized and for people to be able to say ‘Okay, I feel comfortable with it.’”

Lieberman, associated with Hims & Hers, explains their approach to making mental healthcare accessible. Utilizing an asynchronous model primarily through messaging, he states, “We are making mental healthcare available from a person’s cell phone.” This model eliminates the need for appointments, recognizing the reluctance people face in directly approaching healthcare professionals.

He highlights the immediacy of care, expressing the challenges individuals encounter when seeking traditional appointments, often scheduled months in advance. Lieberman shares a powerful quote from his experience, revealing the common misconception: “Ordinary people think you have to be crazy to see a psychiatrist. It’s the last thing you do, and so people wait and wait, and wait.”

With the asynchronous model, Lieberman emphasizes the advantage of instant access to care. He illustrates, “With an asynchronous model, you can be seen essentially right away. 2 a.m., you pick up your phone, you decide it’s time to get help, you fill out an online evaluation, and usually within a matter of hours have a response from a provider.”

Hims & Hers: Accessible Healthcare

Hims & Hers initially addressed taboo health issues, such as erectile dysfunction and hair loss, under the brand “For Hims.” The success of providing discreet solutions for widespread conditions prompted the company’s expansion beyond men’s health.

Adding telehealth services was a key move, though asynchronous care takes precedence. Daniel Lieberman emphasizes the efficiency of this approach, stating, “Asynchronous care allows providers to see perhaps twice as many patients as they could otherwise because it’s a very focused interaction.” While sacrificing some aspects of the human element in traditional doctor visits, this model enables immediate and affordable care — a vital factor given the ongoing challenge of provider shortages.

Evolution of Telehealth in Psychiatry

Daniel Lieberman notes a significant surge in mental health problems during the pandemic, coinciding with the widespread adoption of telehealth. Despite a general decline in various statistics, the mental health arena appears to be an exception.

“In psychiatry, everyone I know is primarily conducting telehealth visits. It’s a matter of convenience,” Lieberman emphasizes. In contrast to traditional in-person visits, telehealth allows patients to connect within minutes from their desks, avoiding the hassles of traffic, parking fees, and waiting rooms.

Lieberman envisions a lasting impact, stating, “Telehealth is perfect for psychiatry, and I don’t think it’s going to go away.” The efficiency and accessibility provided by virtual consultations seem to have become a staple in the field.

When asked about the potential for further growth, Lieberman believes telehealth has reached its peak. During the pandemic, the adoption rate was close to 100%, and he observed a sustained preference for remote interactions. While acknowledging certain in-person procedures, Lieberman highlights that the majority of psychiatric treatments involve discussions, prescriptions, and pharmacy coordination — tasks easily accomplished through telehealth.

Engagement in Mental Health Applications

When asked about how Hims & Hers resolves the challenge of engagement in mental health applications, Lieberman emphasizes the significance of forming a therapeutic alliance, especially in telehealth’s asynchronous model.

According to Lieberman, engagement and retention pose significant difficulties in telehealth, where patients interact with a team of providers without face-to-face consultations. To overcome this hurdle, Hims & Hers takes a personalized approach. Lieberman states, “We encourage our providers to address the human aspects of things because it’s more challenging to develop that therapeutic alliance.” This involves going beyond the basics of symptoms, diagnosis, and treatment, fostering a genuine human connection with patients during the intake process.

In response to inquiries about additional challenges, Lieberman points out the novelty of their approach. Hims & Hers prioritizes gaining experience in treating simpler cases before venturing into more complex ones. Safety is important, leading to a meticulous screening process to ensure individuals are suitable for the remote asynchronous model. Lieberman acknowledges the potential disappointment for some patients who seek treatment for conditions beyond the scope of their current offerings.

Daniel Lieberman on MedMatch

Hims & Hers has recently introduced MedMatch, a groundbreaking service that utilizes AI to address a wide range of medical conditions. Daniel Lieberman expressed his enthusiasm for this innovative approach.

“The AI behind MedMatch will be applied to all the different categories of illnesses we treat. We’re starting with mental health because, in my opinion, that’s the most exciting part,” Lieberman stated. He highlighted a significant challenge in mental health treatment, particularly with antidepressants. Despite the various options available, clinical trials show comparable efficacy among different classes, making it difficult to predict an individual’s response.

Lieberman explained the current practice of offering patients a menu of reasonable options based on gathered information. However, he emphasized the limitations of this approach, stating, “This is not a whole lot better than throwing a dart against a dartboard.” The inefficiency is exacerbated by the fact that patients often discontinue treatment after the first attempt, especially in remote asynchronous care settings.

AI, according to Lieberman, presents a transformative solution. He shared a remarkable example of an AI analyzing chest X-rays to determine the race of individuals, a feat seemingly impossible for human clinicians. While acknowledging that human clinicians excel in certain areas, Lieberman emphasized the AI’s ability to find structure within vast datasets.

At Hims & Hers, the integration of electronic medical records and affiliated pharmacies’ prescription data provides a holistic view of patient information.

Advice to Startup Founders in the Mental Health Space

Lieberman emphasizes the importance of bridging the gap between traditional medical values and the fast-paced ethos of the tech industry. He acknowledges the clash between medical traditions, such as “First, do no harm,” and the tech mantra of “Move fast and break things.” Finding a middle ground, he believes, is the key to addressing this conflict and driving positive change in the mental health startup landscape.

Our previous episode was with John Gorman: Medicare & Medicaid Explained