Essays on Digital Technology-Enabled Mental Healthcare Delivery

Abstract

Mental health disorders are a leading cause of disability worldwide, affecting over 700 million people and incurring significant economic costs consisting of direct healthcare spending and lost earnings due to mental health-induced disabilities. The COVID-19 pandemic has exacerbated these issues, highlighting the urgent need for accessible mental health services. Traditional healthcare systems often fall short, particularly due to unique challenges in mental health care delivery, such as stigma and the reluctance of individuals to seek help, as well as a significant shortage of mental health care providers. These barriers are especially pronounced for underserved populations facing economic, geographic, and social obstacles. This dissertation examines the potential of digital technologies to address these gaps through three essays focused on different stages of the mental health help-seeking pathway: initiating care, escalating to professional care, and delivering professional care.The first essay investigates whether mental health mobile apps (MHMAs) can mitigate the inequities seen in traditional mental health services by helping patients gain equitable self- and peer-support. Using detailed usage data from 1,688 users, the study examines the extent to which MHMAs are utilized and beneficial across different socio-demographic groups. The findings indicate that MHMA usage and benefits are statistically equivalent between underserved and better-served populations, suggesting that these apps can potentially promote equity in mental health support and encourage help-seeking behavior, especially among underserved populations. The second essay addresses the challenge faced by patients who have already initiated help-seeking on online platforms but lack timely referrals to professional care when needed. It adopts an abductive reasoning research design and explores the development and exploratory evaluation of an AI-enabled platform designed to improve the mental health service referral process. This platform uses advanced algorithms such as large language models to match users with appropriate mental health services based on their specific needs and socio-demographic backgrounds and deliver the personalized referral process through a chatbot. Initial testing with healthcare providers demonstrates that our proposed AI-enabled online mental health service referral platform has the potential to connect certain patients who have unmet mental health needs with professional mental health services, effectively bridging gaps in service delivery and ensuring timely escalation to professional care for those patients. However, the technology is not universally applicable; it is most effective for certain target populations. The essay also highlights that this AI solution can promote equity by encouraging patients from underserved populations to seek professional care, addressing a key issue where providers, due to long waiting lists, lack the incentive to prioritize equitable service delivery. The third essay investigates the delivery of professional mental health care through telemental health services, focusing on the factors that influence their uptake and impact on mental health condition at the population level. Using 3-digit Zip Code Tabulation Area-level longitudinal data across 19 U.S. states, the study examines how improvements in provider-side technological infrastructure, specifically enhanced broadband access, and telehealth coverage and payment parity laws affect the adoption of telemental health services. The key finding is that these improvements have a synergistic effect: both enhanced broadband access and telehealth parity laws must work together to drive higher uptake of telemental health services and result in better population mental health condition. This synergy is crucial for maximizing the benefits of telemental health and improving overall population mental health. This dissertation makes significant contributions to the healthcare operations management literature, particularly in the underexplored context of mental health services. Addressing the unique challenges of mental health care delivery is vital for improving outcomes and reducing the overall burden of mental health disorders. Firstly, the dissertation underscores the importance of expanding healthcare operations management research to include the entire help-seeking pathway, not just the interaction between patients and professional care providers. By focusing on digital technologies that facilitate the initiation of care and the escalation to professional services, this research highlights how these early stages can significantly influence overall care accessibility and effectiveness, contributing to reducing inequities by ensuring that underserved populations can engage with mental health services from the outset. Secondly, the research emphasizes the need to go beyond the traditional 3A-framework of affordability, access, and awareness in healthcare service delivery. The findings suggest that patient acceptance is a critical factor in the effective delivery of mental health services. Ensuring that patients are willing to engage with the services offered, particularly through digital platforms, is essential for achieving equitable health outcomes. In terms of practical implications, this dissertation offers valuable guidance for policymakers, healthcare providers, and technology developers. For policymakers, the research highlights the necessity of supporting telehealth infrastructure and enacting telehealth parity laws to enhance the uptake of telemental health services. Enhanced provider broadband access combined with telehealth parity laws can work synergistically to improve mental health condition. Healthcare providers can adopt AI-enabled referral platforms to improve the efficiency and accuracy of connecting patients with the appropriate services, thereby addressing a critical gap in the current healthcare system. For technology developers, the findings underscore the importance of designing digital health solutions that are not only accessible and affordable but also acceptable to the target populations. By focusing on these areas, stakeholders can leverage digital technologies to promote equity and efficiency in mental health care, ultimately leading to better population health outcomes.