A warm welcome to the Deeper newsletter, dear reader!
You’re reading this because, just like us, you’re tired of the non-stop tech and startup news cycle, where there seems to be something new and trendy to keep up with in Southeast Asia.
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Without further ado, let’s dive in.
Hey readers, it’s Nikki here! Quick question: how has your sleep been lately? I’ve been having trouble getting some quality shut-eye myself. It’s either my mind is racing at 100km an hour while I’m in bed or my sleep is as shallow as a kiddie pool. I’ve also been having very…vivid dreams lately, which I can remember in detail the next day.
As a self-proclaimed heavy sleeper (I once napped on a rock), this was alarming to me. I consulted our family doctor, Google, and found that I wasn’t alone in this matter. A quick search revealed that people around the world are suffering from worsening sleep conditions too, and it is almost certainly Covid-19-related.
The vivid dreams are also somehow related to the pandemic. Psychologists in the US noticed an uptick in vivid dreams with people conjuring swarms of bees and invisible monsters in their sleep. France-based Lyon Neuroscience Research Center found a 35% increase in dream recall and 15% increase in negative dreams in an ongoing study. And the Italian Association of Sleep Medicine found that many confined Italians are experiencing nightmares and “parasomnias in line with symptoms of post-traumatic stress disorder”.
So what’s a girl to do to get some deep, dreamless sleep around here? Should I delete all my social media accounts and throw my cellphone and laptop in a safe? Or should I open up my Calm app, plug in my earphones, and achieve enlightenment through guided meditation?
Technology has long been proclaimed as a detriment to our mental health. But in times of prolonged isolation and deadly viruses lurking around the corner, it may be possible that technology has a role to play in the healing of our psyches.
Let’s explore that possibility.
TL;DR:
- Covid-19 is sowing fear and anxiety in the public and that’s creating mental health issues on a global scale
- It’s also highlighting the shortcomings of public healthcare in addressing mental health issues in the past
- This has led to the growth of healthtech startups—both startups founded pre-covid and post-covid
- Two healthtech innovations in particular are finding new significance in light of current mental health issues: telehealth and self-guided applications
- This plays a role in evolving mental healthcare as well as indicative of changing attitudes towards mental health
- Some tips on how you can help yourself get better sleep
Masks can’t ward off this pandemic
According to the World Health Organization (WHO), fear, worry, and stress are normal responses to the current situation. The uncertainty of the economic future, the significant changes we’ve had to make, and the lack of physical contact with others all make for a dreary, tasteless soup of a situation.
In some cases, this anxiety manifests itself in vivid dreams, like in my case. But for others, this soup could develop into something much worse.
According to a policy brief released by the United Nations Development Programme (UNDP), research confirms that the pandemic is increasing the number of distressed individuals in various populations.
Countries are recording higher-than-average levels of depression and anxiety symptoms. Ethiopia, for example, recorded a 33% prevalence rate of symptoms for depressive disorder, which is three times more than pre-pandemic.
In the Philippines, the country’s National Center for Mental Health (NCMH) reported a spike in the number of Filipinos facing mental health issues. From an average of 13 to 15 calls a day, the NCMH now receives around 30 to 35 calls a day from distressed individuals. The organization also reported an increase in the number of suicide-related calls as of the end of May.
Not directly related but also notable is the number of divorce requests being made during the pandemic. The Chinese city of Xi’an saw an “unprecedented” number of divorces, so much so that “Xi’an divorce appointment explosion” became a trending hashtag.
The UNDP predicted early on that the pandemic was going to impact mental health for the worst. After the 2008 financial crisis, there was a rise in “deaths of despair” mostly related to suicide and substance abuse, linked to a loss of hope. As economies continue to strain under the weight of the pandemic, UNDP fears a similar impact on the current population’s mental health may be looming.
What’s wrong with depression?
This situation is highlighting the gaps within public healthcare systems. While mental health is considered a priority, countries have historically done very little to address these concerns.
In Singapore, only 3% of the country’s overall health budget is dedicated to mental health. In spite of the prevalence of mental health disorders in the country, the Singapore government does not consider it a long-term domestic priority.
This has a lot to do with culture. There is a stigma attached to having a mental health disorder. One study revealed that nine out of 10 Singaporeans felt that mental illness is a “sign of personal weakness” and those afflicted could “get better if they wanted to.” Individuals who have achieved higher education want to be seen as resilient to stressors and high functioning.
This sentiment is echoed in different parts of Southeast Asia. In Indonesia, mental disorders are seen as manifestations of demonic possession and are shunned, even by family members. They may even be brought for an exorcism.
As a result, very few individuals who have been diagnosed with a mental disorder seek treatment.
More than three-fourths of people with mood, anxiety, and alcohol use disorder (AUD) in Singapore do not receive treatment for their condition. And people with mental disorders who do seek treatment do so after a considerable delay. Those with obsessive-compulsive disorder, for example, sought treatment after an average of 11 years, based on 2016 statistics.
The treatment gap in Singapore is high, with 78.6% of persons with mental disorders refusing to seek treatment for at least 12 months.
Accessibility is also an issue as the number of psychiatrists in contrast to the population leaves much to be desired. There are only 4.191 psychiatrists per 100,000 people in Singapore, based on 2017 statistics from WHO. But this figure moved up to 4.4 psychiatrists and 8.3 psychologists per 100,000 population, based on 2018 information from the Ministry Of Health (MOH).
In Indonesia, Malaysia, and the Philippines there are 0.310, 1.048, and 0.518 psychiatrists per 100,000 people, respectively.
Other factors that contribute to the treatment gap include lack of knowledge on the situation and availability barriers, like long waiting times and lack of services and staff.
The pandemic is also emphasizing the archaic way we view psychiatric care. When we think about getting help for our mental health, we picture face-to-face therapy sessions and prescriptions for Prozac and Celexa. All of these cost a pretty penny and are actually now infeasible thanks to Covid-19.
We’re starting to get a grim picture of the state of mental health across Southeast Asia. We need to change the perception of mental illness, make mental healthcare more accessible to the public, and do so in a way that will be able to scale even in isolation.
What we need right now is to accelerate the digital mental health revolution.
Healthtech is coming to a smartphone near you
Where public healthcare systems have fallen short, startups have arrived to fill the gaps. There are a couple of innovations that have been making headway in the mental health scene the past couple of years: telehealth and self-guided applications.
Telehealth
One big trend in healthtech right now is telehealth, which is the use of digital information and communication technologies to manage healthcare remotely.
An example of a telehealth application is remote patient monitoring, which may rely on computers, mobile devices, or even wearables like fitness trackers to gather patient data outside of a healthcare setting. This allows doctors to create accurate diagnoses without having to conduct the procedures themselves.
One application of telehealth that is finding new importance in light of Covid-19 is telemedicine, which is the specific application of telehealth in monitoring and treating patients in lieu of an in-patient visit.
As Covid-19 is putting hospitals in full capacity and face-to-face interactions now pose health risks, telemedicine serves as a safe and accessible alternative for receiving mental healthcare.
In Indonesia, a mental healthcare platform called Save Yourselves offers paid counselling for people with mental illness via web chat. Another one from Indonesia is Riliv, which matches users to an on-duty psychologist based on the issues they disclose.
Thailand’s version is Ooca, a platform that allows users to have video sessions with therapists through their website or smartphone app. And in Vietnam, a HealthTech startup called Mosia allows users to connect with one another so they can share their thoughts and emotions in a safe space. Mosia also connects peers with counsellors if they need more support.
Self-guided applications
In Singapore, a startup called Intellect aims to democratize mental healthcare through an on-demand mental wellbeing support app. Instead of connecting users to a licensed psychologist or mental health professional, users get 24/7 access to digitized therapy through a “digitally guided, self-serve, and session based approach.”
This helps address the issue of accessibility—with only 4.4 practicing psychiatrists and per 100,000 population, scheduling one-on-one consultations becomes an issue. But through computerized cognitive behavioral therapy, anyone who needs support can receive it when they ask for it.
This application is targeted towards those who need options for everyday mental support, but whose conditions are not grave enough for specialized therapy. It is intended to be preventative, providing early-stage support for those who are experiencing distress in their day-to-day.
The rise in mental health issues and the increased awareness for mental wellbeing in the workplace have contributed to a surge in demand for Intellect in the past few months. The company launched early this year and is now working with over 15 companies to support their employees. Intellect has also recently received a grant from Enterprise Singapore and raised an undisclosed amount of angel funding.
Other examples of self-guided applications include MindFi, which offers three-minute guided meditations, and Malaysia-based Naluri, which offers health psychology-based preventative health programs for at-risk employees. Naluri recently raised US$1.1 million in a pre-series A funding round.
Covid-19 is accelerating growth in healthtech even further
Healthtech investment was rising in the region, even before Covid-19 shook things up.
In 2018, Asia Pacific’s healthtech ecosystem became the second largest in the world with US$6.3 billion in investment. The region continued that momentum by finishing with over US$5 billion in investment across 340 deals by the end of 2019, in spite of projections made in October 2019 that investments would be impacted by geopolitical and domestic headwind.
The sector has since received a renewed surge of interest in the first few months of 2020, and healthtech startups are accelerating rapidly due to the demand and necessity of their technologies during this time as well as the increased investment being channelled into them.
In Q1 of 2020, Singapore-based telehealth platform MyDoc saw a 147% increase in daily active users. The company also reported a fourfold increase in the number of requests from medical providers seeking to digitize their practice. In February, MyDoc opened up a Covid-19 clinic and launched a virtual clinic to provide timely assessments and prevent misinformation from spreading.
Doctor Anywhere recently raised US$27 million in Series B funding to help meet the increased healthcare demands brought about by the pandemic. They have seen a ninefold increase in consultations for chronic medication refills. And around 60% of the doctors in their platform joined between February and April 2020.
The outlook for mental health applications in particular is positive. Global mental health applications accounted for US$587.9 million in 2018, and is expected to generate a revenue of US$3,918.40 million by the end of 2027 at a growth rate of 23.7%.
The emergence of these applications is indicative of the growing awareness and changing attitudes over mental health in Southeast Asia. A report by JWT Intelligence, as reported by e27, titled “The Well Economy: APAC Edition”, reported that 71% of the respondents associated “health” with “mental health”.
With the number of doctors joining online platforms, the practice of healthcare is also evolving. Through AI, machine learning, and other emerging technologies, these startups are changing the face of mental healthcare across Southeast Asia as we know it.
So can I get some sleep now?
The advancements in mental healthcare technology are enough to help me sleep well at night, just because I know I have some place to go to if I ever need the help. If you’re having trouble sleeping at night, the advice is always the same: stay connected, keep busy, form a routine, control your information intake, exercise, etc.
That sounds pretty generic, so we’ve got a few suggestions from the team:
- Use technology to help keep busy. One piece of technology I’ve recently discovered and have been using diligently is Down Dog, a yoga app that’s a part of a bundle of fitness apps to keep your body moving even when you’re stuck at home all day. I find the dopamine kick after a workout is enough to uplift my mood. If you’re not one for exercise (trust me, I get you), then I also use a mindfulness app called Headspace to get some meditation in.
- Use technology to get away from technology. With Content co-founders Jan and Daniel recently discovered the “downtime” and “app limits” functions on their iPhones, and it’s what they’ve been using to disconnect from the harsh reality of social media and current events. It’s what’s helped them maintain their sanity during these crazy time.
- Online shop. This is another personal fave. But you probably don’t need me telling you this, do you? Nielsen data shows that 37% of Singaporean consumers have increased online shopping activities since the start of the pandemic. How many non-essentials have you been adding to your cart?
The pandemic and all of its consequences have been ravaging our health, economy, and mental states, but it’s nice to know that technology is available to help curb some of these issues.
For the longest time, I’ve been told to stay away from screens for the sake of my mental health. But technology is a part of life, and we have the option to use it to get the help we need.
