GovTech Europe chatted with Julian Angern, Co-Founder and Managing Director of German health start-up Sympatient, the first leading digital anxiety clinic.
Julian started exploring VR-based anxiety treatment at the University Medical Center Schleswig- Holstein in 2016, and his diverse experience contributed to the growth of Sympatient. The company transfers therapy content to an app-based cognitive behavioural therapy that uses virtual reality-based exposure for areas of practice. Julian and the Sympatient team were named ‘Newcomer of the Year’ at the German start-up awards, bringing the firm recognition and awareness.
Julian discusses the newest trends and advances in the healthcare field, along with the challenges a new healthcare start-up can face. He touches on the before and after effects of the pandemic and discusses the hopes and ambitions for Sympatient’s future and the mental health sector.
Govtech Europe: What trends did you see in 2022 for mental health? Did you see an increase in people accessing your digital clinic?
Julian Angern: The trends that were happening in 2022, were rather back and forth, at least in Germany. We witnessed an increase in our digital clinic during the pandemic, as care is becoming extremely attractive, especially if you don’t have to leave your home or travel to an office to receive treatment.
During the pandemic, digital health and telehealth became far more crucial in filling care gaps. Patients couldn’t be seen online or in person for quite some time. Hence, a lot of Health providers tried to incorporate digital health or telehealth. More prominently, telehealth which was incorporated with video therapy or telephone consultation.
Right now, that’s been slightly reversed. Some of the telehealth restrictions were raised again for political reasons. Aspects of treatment are no longer available online, there is no genuine therapeutic purpose; it is primarily political in nature.
Behavioural therapy is the gold standard for psychotherapy. Digital health applications often bring most parts of psychotherapy to patients through smartphones or computers, or in some guided setting, directed by a treatment specialist, or in some unguided way.
In Europe, health insurance reimbursement for digital health applications are advancing, Germany has adopted the first regime for this “DIGA” (digital health application reimbursement scheme). The government evaluates your application, and then you have to produce clinical trial data in order to become a digital health application that’s also reimbursed by all statutory health insurances.This is an issue that saw significant changes in psychotherapy that occurred in 2022.
GE: In your opinion, how do you think the covid pandemic has affected people’s mental health?
JA: New studies are still being researched as we speak, where it focuses on how the pandemic has affected people’s mental health. Basically, a lot of things happened, right? If patients have mental health problems, like depression, for example, covid would have impacted it negatively. Patients suffering from depression are advised to be active in order to recover, seclusion really worsened the condition.
A therapist would argue that patients suffering from anxiety disorders are fearful of communicating to others, in person, or to their employer. As a result, it became simpler for them throughout covid. They may have sensed a reduction in their symptom burden, which is deceptive because it does not tackle the underlying anxiety problems.
In summary, it did have an impact on a lot of people’s mental health; many individuals felt stressed out and alienated, and it did raise the popularity of mental health disorders. Anxiety disorders, for example, had a 30% higher prevalence during covid along with depression that increased massively.
GE: How do you think digital therapy will affect the future?
JA: I believe that the major issue with digital therapy is that it must function with an already existent healthcare system. For example, if we invent a solution through Inverto therapy, which is delivered through blended care consisting of an app guidance. Conveying the same effective content as you would receive in a classic therapy. Basically replacing psychotherapy with digital therapy, which is something that is hard to swallow for a treatment expert.
I think that digital therapy is the future of mental health care, in many ways. I believe that in the future, for any type of situation the answer is through digital solutions.
For example, by completing an online questionnaire and determining whether you have a depressive symptom, you can treat milder or less severe forms of depression. Simply by using an app, integration of large data to learn from while progressing is vital in my opinion.
Collecting data from say a thousand therapy patients is something a single person just cannot do. The availability of learning material for treatment professionals, as well as the prospect of digital programmes for patients, such as a comprehensive therapy available at your house.Changes how mental healthcare works in the future dramatically. Healthcare systems are hopelessly overburdened by the mass of patients wanting care. Of course, they are slow to respond, and they are gradually changing. We require digital care routes, which must be integrated with existing system variables.
GE: How is Sympatient hoping to re-define mental health for the year ahead?
JA: We believe strongly in a so-called blended and step care. Now that’s very specific, because it means that we believe that you cannot only give patients an app, right? If you offer a patient therapy, it may be sufficient for some patients, but for some it’s not enough. Furthermore, patients or people actually following through with therapy by just using an app are very low rates.
There is a significant attrition rate in the system, which is why we feel, among other reasons, that we must include the healthcare system with us on this journey. That’s why we believe planned care is the standard or will become the standard in mental, digital and blended care. Simply meaning that we integrate healthcare specialists into patient journeys that are mostly digital. As a patient, you will have personal interaction with a psychotherapist or a care manager. You will then be prescribed an app, from the comfort of your own home.
That is, of course, the most significant benefit, but you will still have key strategic points at which you will consult with a treatment specialist. These may be as short as two or three hours, but they could also be much longer. We believe you will receive better treatment; we can demonstrate this with data. It’s very, very effective training. For example, tackling anxiety; it’s highly successful in terms of the resources invested on this treatment.
Overall, it’s something that is desirable for the system, because waiting times are low with such a blended care solution. We go for blended and for step care, which refers to stepping patients up if they don’t get what they need. Starting at a low level of care for example, a mild anxiety disorder, you would receive just the application with one or two hours of stereo therapist contact. If it doesn’t work, and you realise the response isn’t therapeutic, we’ll step it up, literally. We’ll give the patient more hours of therapist contacts, each individual receives a very personalised framework for both digital care that enables quick healthcare access, in a flexible setting.
GE: What are some challenges that the company faced regarding the roll-out of ‘In Vitro’?
JA: “Anything that can go wrong will go wrong” – according to Murphy’s Law which is an epigram that every healthcare startup might consider. Germany’s healthcare market is amongst the most highly regulated markets in the whole world. To get into the market you need several certifications for data security such as a medical product certification. It’s always a little bit deceiving to say, ‘well, you’re just developing and developing an app’. I have to laugh about it since building software as a medical product is invertible digital psychotherapy.
In order to be successful you need a tech team, a design team, psychologists, psychotherapists, a regulatory affairs team, data security, you need to open a test entry to test your application. As a result, the data is secure.You need the certifications for medical products for an information security system, you need to get reimbursement, you need to do clinical trials, to actually assess the efficacy and efficiency of your solution.
Randomised control trials, for example, are one of the most common things we’ve come across; it’s a tremendous problem for a small company in a league where pharmaceuticals often play. For example “Big Pharma” (global pharmaceutical industry) wants to pass a medication, it does the same process that we have to go through as a startup. That requires a huge profit and quick profit proficient professionalisation.
As a startup, you don’t have the typical make it or break it mindset.You can’t simply roll out prototypes and hope they work. When it comes to medicine, you must be certain that there are no occurrences or hazards that might cause patients harm. As a result, the playing field is unequal in many ways. Of course, if you overcome those hurdles, you will have obstacles to entry to deal with.
GE: What are Sympatient’s hopes in navigating through health care systems in Europe?
JA: I think it’s had much of what we hoped for. What we see in the EU as well, Health care systems are overburdened all over the EU. Healthcare for mental health is a pretty new thing, right? I mean, we’ve been doing this for 100 years, which in medical history is very, very short term. We don’t know so much about that yet. So psychotherapy is quite a young discipline. And there’s so, so much to do, and the systems are overburdened and waiting times are high.
GE: What would you like to see in the future in the mental health sector?
JA: We hope for the systems to be more open to innovation, that they incentivize innovation, because that is something that is increasingly hard to see in, in healthcare systems. They are rather protective of their current state of medicine. And that is a huge, huge problem. We want to encourage everyone to look at concepts, try them out before bedevilling them. That goes for all countries.
We want to see openness to really test it out, to help overcome regulatory burdens, as soon as we enter the EU and grow across EU nations, rather than just seeing us as a threat.I think that’s basically the most important thing, because the treatment itself can be quite the same all over the EU. It’s mostly regulatory affairs, and politics about the market access and reimbursement in the US system, where harmonised standards are, of course, something that we would wish for.
Sympatient plans to overcome regulatory hurdles while growing beyond the German market, all while highlighting the facts and hardships that a healthcare business might face. Julian believes that digital therapy is the way of the future, with digital solutions and flexibility opening the door to rapid, accessible, and comfortable health care.
Source: Sympatient
