For the past decade, we’ve all been talking about digital solutions as the key to unlocking universal access to mental health care. We’ve certainly come a long way, but not necessarily from an equitable standpoint. Today, there’s an increasing number of digital mental health platforms available and many payors are now including digital mental health services in their membership plans. However, reach, usage rates, and service retention numbers reveal something is hindering further progress. It’s important to ask our field: What have we achieved during this time, and more importantly, what still needs to be done to unlock universal access?
It’s critical to first highlight the difference between equality versus equity in mental healthcare. Equality in mental healthcare means providing the same level of resources and services to all, regardless of an individual’s needs or circumstances. This assumes, of course, that everyone starts from the same place and requires the same level and type of support. However, this does not address the unique needs of certain populations, such as language barriers, food or housing insecurity, digital access, or household demographics.
Conversely, equity in mental healthcare recognizes that people have widely differing needs and circumstances. True equity ensures that everyone receives the tailored support and resources they need to achieve comparable outcomes, regardless of their individual circumstances or challenges. Truly equitable mental healthcare addresses diverse factors that affect individuals’ mental health and their access to care; equitable care recognizes that we cannot take a one-size-fits-all approach. A pathway to ensure everyone has the opportunity to achieve optimal mental health and well-being is critical.
Barriers to Mental Health Support in Diverse Populations
Socioeconomic, geographical, cultural, and linguistic barriers to mental healthcare exist across the U.S. and globally. In rural and remote communities, where cellular signals may be weaker than in more densely populated areas, taking advantage of digital solutions can be disproportionately difficult. In California's agricultural communities (whose hard work feeds not only California but the entire U.S.), there might not be dollars to spare for a data-enabled cell phone. Non-native English speakers have unique linguistic challenges when it comes to accessing care, as do those without stable housing or transportation.
For some people, these barriers to care exist at every turn, so digital solutions need to be viable and able to reach them where they are. No matter how transformative your program is, its impact depends not only on how many people know about it, but also how many people can access it.
Designing a Mental Health Platform for Diverse Populations
Although universally accessible platforms delivered via internet-enabled devices address equality, we have yet to solve for health equity. To do that, we need to build and adapt platforms to meet different needs of diverse communities.
At Kooth, we serve young people, so we've involved them throughout the entire design process. Over 300 Californian youth helped co-design Soluna and we continue to champion youth-led co-design so that Soluna continues to be a mental health support resource made for young people, by young people.
It is critical to integrate culturally and linguistically appropriate support while addressing the digital divide, socioeconomic barriers, and geographical obstacles to care. Content customization that is representative of the people who are consuming it and using these tools is vital to ensure solutions are inclusive and effective. If you’re building a product for first-generation immigrants, for example, then you need to co-design and build a solution with that community.
Solutions must also consider the needs of individuals with physical, intellectual, and neurological differences. The Institute for Exceptional Care (IEC), this year’s nonprofit partner for BHT, is a national nonprofit committed to making healthcare better and safer for people with intellectual and developmental disabilities. To achieve this, IEC partners with people with lived experiences, family members, and healthcare professionals to transform the way care is taught, delivered, and funded.
Collaboration Between Public and Private Entities
At Kooth, we've found that achieving mental health equity, as opposed to equality, requires collaboration. This includes partnering with young people as co-designers and gaining support from government entities. In California, everyone 25 years old and younger – some 13 million children, teens, and young adults – now have free access to two digital mental health and wellness services: BrightLife Kids and Soluna. It’s part of California Gov. Gavin Newsom’s historic $4.7 billion Master Plan for Kids’ Mental Health and the Children and Youth Behavioral Health Initiative (CYBHI). Governor Newsom has made children’s mental health a cornerstone of his administration’s agenda, with a particular focus on ensuring equity of access for marginalized communities who face disproportionate barriers to care.
For children aged 0-12 and their parents and caregivers, BrightLife Kids offers free access to behavioral health coaching, on-demand content, and tools. For young people aged 13-25, Soluna offers self-guided resources, a fully moderated peer community forum, and on-demand access to behavioral health coaches and care navigation to build a safe community. Together, BrightLife Kids and Soluna provide support for every young person in California – exactly when and where they need it. It’s a meaningful, impactful demonstration of commitment to addressing youth mental health and mental health equity, and can serve as a blueprint for other state legislatures, departments of health, and boards of education to implement for their young citizens.
We’re incredibly proud of our partnership in California and what we’ve achieved in our first year. Early data from the partnership demonstrates that we’re reaching diverse young people across the state. We have users in all 58 counties in California, with a fairly even age distribution (ages 13-15 = 23%; 16-18 = 29%; 19-21 = 20%; 22-25 28%). More than half (53%) of users live in underserved communities as measured by the Healthy Places Index, and 32% report speaking one or more languages other than English (18% Spanish; 14% Other). What’s more, users like what they see: 97% of Soluna content is up-voted and 95% of users would recommend Soluna to a friend. This early data tells us we’re on the right track in reaching diverse young people with a platform that resonates.
But, as we in this field know all too well, there’s always more work to be done. At Kooth, we’re committed to doing this work, and we have great partners supporting us. To ensure teens have unencumbered access to mental health care, we’ve got to commit to all doing our part in creating truly inclusive, accessible solutions. This starts with aligning with our user populations from the onset to create products and services that strive not just for mental health equality but make mental health equity a reality. And we’d love some company on this journey.
Hear more about how Soluna is shaping the future of youth mental health through our upstream approach. Join us for the panel discussion, Upstream Evolution: Shaping the Future of Youth Mental Health, featuring Dr. Harris Eyre, Dr. Jayme Banks, Dr. Jen Huberty, and Katie Rudek (moderator) on Tuesday, November 5, from 4:15 to 5 p.m.
