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A Look at the Gaps in Mental Health Care – An Interview with David Shern, Ph.D.

Monday, March 24, 2014


shern-bio-pic_0We recently sat down with one of the nation’s leading mental health experts, David Shern, PhD. Here’s what he told Karan Singh ( about the past, present, and future of mental health:

KARAN: We’d love your opinion on how things have changed in mental health over the past 30 years and where the biggest gaps currently sit.

DAVID: We’ve made big strides in regards to the de-stigmatization of mental illnesses. These illnesses are now regarded as legitimate health conditions and we have an armamentarium of treatments available. I think that the Mental Health Parity Act and the Affordable Care Act reflect these changes. Although we’ve come a long way and made enormous progress, there are still some big gaps in terms of unmet needs. We continue to run up against problems that relate to the structure of delivery systems as well as the accessibility of technologies that we offer. There’s a huge gap in terms of what we know to be the need for services and the rate at which people receive those services.

KARAN: And what do you think are the causes of the unmet needs?

DAVID: We’ve historically discriminated against mental illnesses and addiction conditions in insurance coverage. Mental health treatments were not mandatory benefits, had higher co-pays, and experienced more stringent utilization management — all of which continued to discourage use. We’ve made some progress with the parity legislation, which states that if there is a mental health benefit offered, it has to be offered at parity to the general health benefit. We’ve also historically under-detected these conditions in primary care. Continuing public ignorance and the shame associated with these conditions are lingering influences on decreased utilization.

KARAN: Can you talk about how primary care is stepping up to help identify those in need of services?

DAVID: The most common mental illnesses are depression, anxiety disorder, and substance use conditions. Most people with these conditions don’t get into specialty care — they’re seen in primary care. Traditionally, these conditions have not been detected in primary care settings. Years of research and physician education has started to change this and the frequency of standardized screenings for mental health conditions in primary care is increasing. We’re not where we need to be — there is still substantial under-recognition of these conditions in primary care — but we’re making progress.

KARAN: What do you think is driving the integration of mental health into primary care?

DAVID: I think a few things. First, the availability of safe and generally effective medications has given primary care physicians a new strategy for addressing depression and anxiety. Second, the pharmaceutical industry has done a good deal of direct to consumer marketing which has further ‘normalized’ discussion of treatment. The pharma industry’s work aligned with advocacy organizations’ agendas, like Mental Health America, to continue work on de-stigmatization and public education. A third influence is the increasing realization that depression, anxiety and addictions are common and are great complicators in the management of health generally and other chronic illnesses specifically. Fourth, is the research and testing of brief, reliable, screening instruments, such as a PHQ-9, which makes the ability to screen so much easier.

KARAN: Within care settings, what types of intervention are you seeing work best once an individual is diagnosed?

DAVID: We have some good, strong science based models around depression treatment in primary care. The best models have been developed in organized care settings, like the Group Health Cooperative in Puget Sound. In over 30 randomized trials, we’ve seen that collaborative care programs in which a behavioral health caregiver is present right in the primary care setting is very valuable. By responding to an individual immediately, as opposed to a delayed referral to the specialist — which is rarely followed through for a several reasons — we can start to engage the person right away and help them understand what’s going on in treatment and what their options are. These programs have been shown to significantly reduce levels of depression for as long as 5 years.

KARAN: So as we get better at diagnosing in the primary care setting, how can we fill the gap between those treated and not?

DAVID: I think it comes down to more active care management, which has been hard to do because of the structure of our healthcare system — specifically with solo practitioners and small practices that don’t have the resources to offer immediate behavioral health support. We need to link people to things that help… things that are available anytime, anywhere, at an affordable cost. For these reasons, I’m particularly intrigued by technological solutions, such as and others, to try and fill that gap. Once perceptions of technology in terms of availability and accessibility are improved, I think we’re going to see a very important difference in access to help. I also think that linking people to natural support mechanisms in their community — getting people involved in their own health and the health of others — offers great promise for addressing some of the gap. We’re excited about the emerging role for advocacy groups, such as Mental Health America, to empower people to do more in terms of recovery for themselves with appropriate, professional support.

KARAN: What do you think is standing in our way from filling the gap?

DAVID: We’re getting better at using the PHQ-9 but it still isn’t like a thermometer or a blood pressure cuff . We have the evidence that care management strategies work but we need to have financing models to support them and the capacity to deliver evidence based care in terms of technology and personnel. When it comes to finances and capacity you have to be thinking about running a practice — how will you have enough volume to make these approaches affordable? I personally think for this reason and many others, we’re going to see a shift away from solo and small group physician care into organized systems of care like the staffed HMO model.

KARAN: I’d love your thoughts on why you’re excited about the Mood Matters program.

DAVID: I just think, and others in the field agree, that we need some new breakthrough technologies. For a long time, we focused on psychotherapy and pharmaceuticals and we’ve made important progress on both fronts but things like hold tremendous potential for closing some of the gaps that we just discussed. Part of the reason we’re excited about working with is that we see it as another element of the spectrum of approaches available that can make the community as a whole healthier. As we can collect data passively, we open up a whole new dimension for health that could make a big difference for people. I just think the right idea at the right time — and I know you do too.

We Need your Help to Win the National Council eHealth Challenge

Friday, March 7, 2014


We’re excited to share that is a finalist for the National Council eHealth Challenge! We are nominated alongside five other great companies and need your help to win the grand prize.

The winner of the contest will receive a National Council magazine article and press recognition to spread the word about their behavioral health initiatives. First prize will be awarded to the company with the most Facebook video “Likes”.

You can help us win the contest by clicking LIKE on the Facebook video.

At, we want to make sure that everyone gets the right support, at the right time. We’re driving towards better care for people with behavioral health conditions and appreciate your support to make it happen!

Vote now >>

Voting closes April 1st, 2014. You can also help us spread the word by sharing this link with your friends and family: **Please note that only “Likes” on this specific video (not shared posts) count towards the total.

Introducing Mood Matters™, a Program

Friday, February 28, 2014


moodmatters_pixeltree_horizontalAt, we’re passionate about pushing the boundaries of mental health research. This is why we’re excited to launch Mood Matters™ for depression.

Depression affects 1 in 10 people, and goes undiagnosed for many. With the right support at the right time, depression is treatable. At, we’re working to help you identify the “right time” through a deeper understanding of your daily patterns.

The Mood Matters™ program uses our platform to understand the triggers that lead to episodes of poor mood. Participation is completely free and is currently open to individuals who:

— Live in the United States
— Are between the ages of 18 and 65
— Own and use an Android or iPhone smartphone
— Are currently experiencing symptoms of depression

To see if you’re eligible and sign up for Mood Matters™, visit Named One of World’s Top Ten Most Innovative Healthcare Companies

Friday, February 14, 2014


At, innovation has been a guiding principle of our work since our early days at the MIT Media Lab. For CEO Anmol Madan, “Disruption is solving a problem from first principles — what should exist, but doesn’t. Then being fearless enough to make it so.” Our team is focused on bringing disruption to healthcare by making behavioral analytics — understanding how daily patterns impact health state — a core part of care.

We’re excited to share that others are recognizing our disruptive potential. Fast Company has named us one of the Ten Most Innovative Companies in Healthcare. For our team, this is further validation that care must transform from episodic data collection to continuous insight — and that we’re the right company to drive it forward.

Interested in bringing innovation to your health system? Reach out to us at to find out how we can work together.

2013 Year in Review

Wednesday, January 1, 2014



Welcoming Julia Winn (BetterFit) to the team

Monday, December 9, 2013


winn demo cropped
Read more about Julia’s journey in an exclusive interview with Health 2.0

We’re delighted to welcome Julia Winn, founder and former CEO of BetterFit Technologies, Harvard spin-off and an alum of the Techstars Boston program (2012), to the family.

Julia built the first prototype of BetterFit during her senior year at Harvard College. A year later, BetterFit graduated from the Techstars Boston program, raised seed funding, and deployed with its first paying customer.

BetterFit focused on individual patient care built around natural language processing. BetterFit’s initial product was a tool to predict how a person would react to a new drug based on her reactions to previous drugs. Over time, Julia and her team realized the complexities in doctor-patient communication, and pivoted their platform to enable automated, personalized text message conversations with patients between doctor visits.

Enhancing the provider-patient relationship using machine learning is core to the mission, just as it was for BetterFit. In a changing healthcare landscape, we believe in finding talented leaders like Julia who can help us find creative answers to both technical and business challenges. In addition, we have other team members that bring outstanding experience to, including our product manager Sasank Munduri (Google), Jimmy Do (Pipette), an expert in mobile computing, and senior engineer Jeremy Johnson (Healthonomy). As a company, we pride ourselves in our entrepreneurial spirit and can-do attitude, which is essential for driving change in a complex industry.

Julia is already hard at work helping us think through some of the biggest strategic questions facing, a valuable asset as we focus on deploying our platform with innovative healthcare partners. If you’re interested in learning more about our strategy and/or working with us, please reach out to us at or on twitter at @ginger_io.

Time for the second annual Teamsgiving!

Thursday, November 28, 2013


Anmol bbq
Last year, we kicked off the holiday season with Teamsgiving, a chance for all of us to reflect on what we are thankful for as part of the team. This year, we’re putting a slight twist on it and making it a tweetable #teamsgiving! You may have seen some of our thoughts over the past week on twitter — here are a selection of the rest!

A couple of themes have emerged – we’re thankful for the chance to work on something with impact, to work with committed clinicians and patients, and to work with each other. And don’t forget the ping pong table!

Let us know what you think — if you’ve worked with the team, what are you thankful for?

Ilan Elson Schwab (@elsonschwab): I am thankful for good health and the great partners we have that are excited to promote more good health.

Peter Smith (@petersmithus): I’m thankful for working with clinicians and colleagues who embrace the mission of proactive care and improved patient outcomes.

Naomi Kincler (@namikinc): users who are trailblazers, working tirelessly to improve their own health & help better the health of others by simply sharing their experience

Karim Wahba (@karimwahba): Thankful to be working with a wicked awesome team @ginger_io on a truly worthy cause

Jeremy Johnson (@jeremyajohnson): I am thankful to be impacting the way healthcare is delivered in a scalable fashion with a talented team that truly cares.

Julia Bernstein (@jfbernstein): I’m thankful to work on an inspiring mission and work w/ people who can help make it a reality, both in and outside @ginger_io

Kate Farrahi (@kfarrahi): Thankful to have met so many interesting and talented people at Ginger and to be part of the exciting data science team.

Mahesh Sharma (@maheshsharma): Thankful for all the amazing people I get to work with, just like a family away from home 🙂

Julia Winn (@julia_winn): I am thankful to work with so many incredibly talented people who are all trying to make a difference in healthcare.

Michelle Patruno: I’m thankful for our wonderfully supportive team. Our teams love of food and terrible movies. And all of the new additions!

Sai Moturu: I’m thankful for a thoughtful team, a growing data science group and the new ping pong table 🙂

Integrating mental health into primary care: an idea ready for the mainstream

Friday, November 8, 2013


CIHS infographic
Image courtesy of

At, we hope for a future where mental health is central to managing a community’s health. As we discussed in our last post, addressing mental health is particularly crucial for helping patients manage other chronic diseases like diabetes, lung disease and cancer. Our dream is for our technology to be a part of the revolution integrating behavioral health as an essential component of any well-functioning primary care system.

If you follow our blog posts, you probably already know how much we care about mental health. It’s still sobering to think of how broadly mental health problems affect our country: a 2008 report estimated that 26% of Americans suffer from a mental health disorder, and that 6% have a severe disorder. This adds up to nearly 60 million people in America with a mental health disorder. That’s staggering.

These statistics aren’t just faceless numbers, either. I encounter the reality of the burden of mental illness in my clinical work every day. It’s the young man with untreated multiple sclerosis with progressive pain and weakness because of an undiagnosed mental illness manifesting as uncontrollable irritability and anger that no physician had tried to treat before. Or the middle-aged Dominican woman with depression and knee arthritis who didn’t treat either problem and bounced from primary care practice to primary care practice because no one could find her a Spanish-speaking therapist. A common story I hear from patients is that it was just too hard to find a mental health professional, so they stopped looking.

The most credible proposal to fix the problem of mental health access is fundamentally changing how mental health care is delivered. Instead of piecemeal access for whoever is lucky enough to have a psychiatrist, psychologist or social worker nearby, health systems across the country are transforming their primary care infrastructure to integrate mental health care directly into primary care. This makes sense for a number of reasons:

1) In the US, Primary care providers are the frontline for medical care. They are better suited than anyone to address mental health in their communities. It has been estimated that up to 70% of primary care visits stem from psychosocial issues. In addition, diagnosing and treating mild or even moderate mental illness is not too complex for primary care physicians. However, it makes practicing much easier to have the support of a behavioral health infrastructure to back up your decisions and help with complicated cases.

2) Payment reform and the Accountable Care Organization movement means that treating mental health doesn’t mean losing money. In most markets today, mental health care reimburses poorly, leading to closure of psychiatric facilities and prompting health systems to avoid developing a strong mental health infrastructure. However, payment models are increasingly switching from purely “fee-for-service”, where physicians get paid for every service they provide, to a “bundled payment” model, where physicians get paid a fixed sum to take care of a large population of patients. At a high level, the overall incentive in the bundled payment model is for physicians to save money by improving their populations’ health to reduce avoidable health care use. And it turns out that treating mental illness is a very effective way to avoid excessive health care utilization.

3) There is also accumulating evidence that primary care and behavioral health can do amazing things when they work in the same place. The most widespread model is the IMPACT program, which involves integrating a psychiatrist and population care manager into primary care to manage depression.  This team, together with the primary care physician, can provide much more comprehensive management and follow-up for patients with depression. The model has spread to over 500 clinics across the country.

4) There’s also legislation to help increase mental health access for all: in Massachusetts, a bill is being proposed the would compensate psychiatrists for electronic visits at the same rate as an in-person visit, which could be transformative. There are also pilots of electronic psychiatry visits, or “telepsychiatry” being piloted in over 40 states.

I’ve seen all of these factors in play firsthand. My clinic happens to be one of those great places where primary care and behavioral health can work together. On my clinical team, there’s a social worker who meets with our population manager and a psychiatrist weekly to coordinate care for all of our patients with mental health needs. If I meet a new patient who has a mental health need (and many do), I have them fill out a comprehensive form and then our social worker helps to find the right place for their mental health care. Together with the social worker on my team, we have helped almost all of my patients with serious mental health needs into the loop of the best mental health professional they needed. And once that loop is established, we are in continuous contact about how to thread together our patients’ mental and medical health care. By integrating behavioral health into primary care, we are able to treat the whole patient, not just the symptoms.

How do you integrate mental health into primary care? Join the discussion on twitter by letting us know at @ginger_io!

Why Mood Matters

Monday, September 30, 2013


Note: This was cross-posted by our partners at UCSF’s Health eHeart study. Sign up today to contribute to the fight against heart disease!

health eheart question

A New York Times article by Columbia’s Dr. Eric Kandel makes a convincing argument for the “New Science of Mind,” which posits that our minds are directly connected with the biology of the brain.  Along with, we believe that our minds are also connected with the biology of the body. Understanding our mental health, not only our physical vital signs, is critical.

This may not seem intuitive at first — it’s easy to understand how an objective physical measure like blood pressure or heart rate impacts a condition like heart disease.  It can be harder to make the connection between a “soft” question about something like mood and a chronic condition. However, a new body of research is convincingly making the case that mental and physical health are closely linked.  Understanding mood change could very well help us understand why some people develop a chronic condition, or respond better to treatment.

In particular, a number of studies looking at the impact of depression and anxiety that are co-morbid (or present with) chronic conditions have found a real connection to quality and cost of care.  In general, people living with chronic conditions have rates of co-morbid depression ranging from 25-50%.1 This translates to a real personal and economic impact — undiagnosed patients are less likely to be adherent to treatment protocols, which can lead to costly complications.

For example, research has shown elevated levels of depression after diagnosis in cancer patients (and their spouses).  Similarly, people living with diabetes are at high risk for depression (as well as stress and anxiety).  For heart disease, it’s a similar relationship, with both a higher prevalence of depression (40 to 60%) among heart disease patients, as well as a possible biological rationale for that number in how our bodies react to stress.2

And the relationship goes both ways. In addition to chronic conditions leading to elevated levels of depression, depression can also impact whether someone may develop a chronic condition.  According to a recent study, “depressed older adults (defined as those over age 50) were more than twice as likely to develop vascular dementia and 65 percent more likely to develop Alzheimer’s disease than similarly aged people who weren’t depressed.”3 These statistics hold for conditions like heart disease, where “30 to 50 percent of patients who suffer clinical depression are at risk of developing cardiovascular disease.”4

Given this clear relationship between mental and physical health, how do we measure something that seems so subjective?  Self-report questions can be a good starting point.’s research, done at MIT Media Lab shows that you can use self-report answers to train a model to find patterns in sensor data — like the movement and communication data from your phone — that suggests when someone might be feeling down.

So that’s why we ask mood and related questions — to help us better understand the relationship between mental and physical health.  With your help, we can make providing the best care for both mental and physical well-being part of how we treat chronic, and often go untreated.  In addition to the psychic cost of conditions.

Want to get involved? You can sign up for UCSF’s Health eHeart study and contribute to our understanding of CHF today. Or join the conversation on twitter at @ginger_io and @Health_eHeart.

Looking for more information? If you or a loved one is currently struggling with co-morbid depression, this booklet from the Behavioral Diabetes Institute is a good source of information.


What we learned on our summer co-op

Friday, September 6, 2013


This past summer, Jennifer Blight and Jonathan Acevedo, students at the University of Waterloo, joined us as engineering interns.  While they were here, we all learned a lot about Canada.  We asked them to reflect in turn on what they learned from us. interns

The grumblings of Samuel Clemens aside, San Franciscan summers still have nothing on Canadian winters. It’s been an amazing four months for the Waterloo interns here.  We both feel that we’ve learned a lot in a very short time. Hopefully we have become better developers for it; but often the biggest challenges are not about writing code. These are a few of the ‘life lessons’ that will accompany us as we return to the frozen North.

Ask Stupid Questions

Everyone here has their own area of expertise, no one knows everything, and the whole team is open to questions from anyone about anything. You’re not just encouraged to ask questions, you’re expected to; because you learn faster, and produce better results more efficiently if you get the right information quickly, rather than fumbling around by yourself. So ask questions. Ask about your work, ask about other people’s work, ask questions even when you think no one has time for them.

(and ask “Why?”)

Understand the logic that goes into each decision. Be critical. Why am building this? Why do we do it this way instead of that way? The answers to those questions aren’t just for your information; the act of explaining makes the answerer accountable for their reasoning.

Your Opinion Matters

Your opinion matters more than you think. One of the first things that we were told is: “Everyone on this team will treat you as a full time employee.” This has been true throughout our entire internship. Overhear someone talking about the product you built? Feel free to step in. Brainstorming new product ideas? Jump in. Racing to the finish line for the team scavenger hunt? Sprint ahead.

The entire team is constantly striving to learn, innovate, and to better themselves. Everyone is trusted to be in charge of their schedules, and the work that they do.

Own Your Work

Perhaps one of the hardest things about being an intern is unlearning the instincts of a student. There are no predefined requirements, no rubrics and, often, no right answers. You’ll be given a lot of autonomy and expected to make your own decisions about scope and direction. We have many mentors, but often there’s no direct supervisor. You have to be self-directed, explore, figure things out, and occasionally take leaps. The result is a project that is completely and uniquely your own; something you have nurtured from its inception and something that you will be reluctant to leave.

Want to join the conversation? Let us know what you think at @ginger_io. And check out our team (and our openings)