Digital triage and the human touch

Justin Norden, MD, MBA, MPhil · February 22, 2021 · Short URL:

How emerging technologies are relieving the pressure on our mental health system

With demand growing for therapy, counseling and medication--but with an inadequate number of mental health providers--we are at a crossroads today as we set about fixing our country’s troubled behavioral and mental healthcare system. 

We could train and license hundreds of thousands of Americans to become mental health professionals, or we could use the toolkit we already have in front of us to offer new programs that have not been tried before. This toolkit includes artificial intelligence which could extend the reach and effectiveness of every provider who is working today.

Speaking as both a physician and a technologist, my vote is for the latter, and not just because the former is unrealistic and untenable. Artificial intelligence has evolved to the point where it is ready to assume a far more important role in our country's delivery of mental healthcare.

And—to some people’s surprise—the people in need of care want to see technology take on much of what used to be the sole domain of the psychologist, psychiatrist or counselor. People really will bare their souls to a chatbot, a robot or an AI algorithm. In fact, a large number actually prefer it.

While the real work of understanding and treating patients will always be the role of the mental health professional, there is far more that technology can do to improve a mental health system that was strained before COVID, and is past the breaking point today.

As an investor, I’m finding and backing technologies that blend the digital with the human in order to create a mental health system that will benefit more people. I am confident technology will broaden access without compromising quality.

Technologies That Intrigue Me In 2021 

With the proliferation of mobile technology over the last two decades has come numerous applications to help people manage stress, sleep better or record the symptoms of anxiety or depression. But recent times have seen regulatory and reimbursement momentum behind many of these innovations, meaning that mass adoption could be in the cards for some of them. 

With that in mind, I’m betting on the future of these technologies: 

Digital therapeutics

I like technologies that do what our mental healthcare system cannot: staying close to patients 24 hours a day, and intervening when patients need help. Anyone with an Apple Watch, for example can put an end to nightmares caused by PTSD by using the NightWare program, which makes the watch vibrate when the wearer’s vital signs show elevated stress levels. People recovering from substance abuse disorder--many of whom won’t get face-to-face counseling for hours every day--can engage in cognitive behavioral therapy offered by Pear Therapeutics, which stands apart from the herd of mobile digital health products with its FDA approval. 

Furthermore, numerous digital therapeutics are being developed for areas that have few treatments available. Their developers include AppliedVR, which has a program for fibromyalgia and low back pain which received breakthrough designation, and Limbix, whose prescription software treats adolescent depression.

Chatbots to triage care

AI-enabled chatbots can be used to steer people to the appropriate mental healthcare, so that the precious few mental health professionals working today won’t have to do it. Some people just need someone to talk to, while others need the intervention of a psychologist or psychiatrist. Using AI programs in the triage role frees up mental health professionals to focus on delivering care to the people who genuinely need it.

Digital triage is already working in primary care and in other areas, as evidenced by the progress of companies like 98 point 6Buoy HealthBabylon and others. It can work in mental health too, and it is sorely needed.

Digital Biomarkers 

Digital biomarkers are predictive and diagnostic solutions based on passive metrics, including a person’s mobile phone usage, linguistics, movement or other modalities. Companies like Ginger and Mindstrong have laid the groundwork in this exciting new area, which has plenty of room to grow.

Capturing passive analytics about how someone is using their phone--even down to how they type--begins to paint a picture of someone's disease, and potentially symptoms such as psychomotor retardation which can be seen in depression. Even sleep-wake patterns offer insights. Voice is another digital biomarker, and some companies, like Vocalis Health,  are working to link vocal samples with suicide risk, anxiety and other conditions. While many of these technologies are in early days, it is clear that these objective signals over the coming years will change how mental health care is provided.

Telemedicine and asynchronous solutions 

Telemedicine has made life easier for patients during COVID-19, allowing them to adhere to social distance guidelines while saving time and money on travel. But it can do more for providers, specifically in the area of mental health. What’s needed are solutions to help mental health professionals treat more people--not just transition them to video to treat the same number. Asynchronous communication is one way to make that happen.

Companies like Alpha use asynchronous communications in primary care and mental healthcare. It lets patients contact their providers frequently with questions about their health, for example in matters of questions about symptoms or medication refills. These technologies steer simple inquiries like these to lower-level staff or even AI programs, taking weight off of clinicians.


We’ll never automate mental healthcare delivery or replace the human empathy that guides the mental health profession. We need every mental health professional we have, but we need to use a more robust set of tools to extend their reach and enhance their impact.

Although patients will open up to a chatbot or an AI program, these technologies will never heal the patient. But they will offer much-needed help to the professionals who do.

(Editor's note: register for Vator's May 19 Future of Mental and Behavioral virtual event. We'll have top-level VCs and C-level executives from the leading mental and behavioral companies, such as, Teladoc's BetterHelp, Amwell, Doctor on Demand, Kaiser Permanente, Bessemer Ventures and more.)

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Justin Norden, MD, MBA, MPhil

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