Can Extended Reality (XR) help us address the mental health crisis? Unlocking the potential of this promising sector

We’ve all heard the story: the Covid-19 pandemic accelerated a boom in the already growing HealthTech sector, with scaling innovations in remote care quickly becoming a necessity and bringing along with it a boost in applications of other new technologies across health and care. While this story is both largely true and verging on ‘old news’, there is a particularly exciting slice of the sector which - despite only just starting to get its legs in health and care - is poised to make significant impacts on how we deliver care: extended reality (XR). 

While XR may conjure images of families stuck inside during lockdown experimenting with VR headsets, these technologies are already being used across health and care in a number of contexts. One of the most promising use case areas is within mental health treatment, where XR has demonstrated the potential to make particularly meaningful impacts. The value for patients of this opportunity should be clear, given the growing scale of mental health concerns nationally with reports indicating that 1 in 4 people in England will experience a mental health problem every year and treatment estimated to be costing the UK economy over £100 billion a year. If we can effectively improve mental health treatment through innovative applications of XR, we stand to make huge impacts on patient outcomes and quality of care across an area of particular - and growing - public health concern. Yet to achieve this, we must understand the current barriers to adoption and identify what  can be done to address and overcome them.

First, let’s cover the basics: XR refers to Extended Reality and covers Augmented Reality (AR), Mixed Reality (MR), Virtual Reality (VR), haptics, interfaces, platforms, and software and is often referred to as ‘immersive technologies’. The global immersive technology market is accelerating out of the pandemic and reaching the tipping point of wide scale penetration in both the private and public domains. Worldwide spending on XR is forecast to accelerate, growing from just over $12 billion in 2020 to $72.8 billion in 2024.

Within the UK health and care sector, XR tools are already being used - though we are certainly still in the early stages of adoption. Initial use cases range from training future pharmacists using VR headsets to empathetically interact with patients in a controlled environment to virtual simulations giving surgeons greater access to theatre time and ability to rehearse complex procedures. In addition, the NHS are creating a Dynamic Purchasing system to aid the procurement of  best in class XR, immersive learning and related technologies. The use of these technologies in the health and care sector has reduced the use of restrictive practices, limited the impact of Covid-19 measures and improved the experience and outcomes of service users. As a result, they are increasingly being considered as reliable, cost-effective and innovative solutions to consider.

Mental health specifically is a growing concern nationally, as reflected by the NHS Long Term Plan and devolved government policies making a renewed commitment to improve and widen access to mental health support, more effective and cost-saving measures are needed. The UK Government and wider health and care sector have recognised the potential for digital therapeutics solutions across the UK, with NICE recommending nine new digital therapies for patients with depression and anxiety in March 2023 to free up clinician time by potentially halving the time spent on standard care. Similarly, digital services improve individual accessibility and reduce stigma associated with accessing mental health support and traditional talking therapies, ensuring support for a greater proportion of the UK population, across ages and cultures. 

Despite this growth in the immersive technology sector and an increased adoption of digital therapeutic solutions for mental health treatment, there has not yet been an approved digital therapeutic using XR/immersive technology for mental health treatment on the UK market. This gap is certainly worth bridging, with research showing immersive technology’s effectiveness as a mental health treatment within several conditions including neurodevelopmental disorders, psychotic disorders, depression, anxiety disorders, phobias, trauma and eating disorders.

New strategic support to bring together immersive technology providers and innovators in the XR sector with clinicians and researchers could fast track new R&D and solutions to deliver on this demonstrated effectiveness and make positive impacts on the mental health needs of patients across the UK.

XR for mental health treatment: What’s holding us back?

Launching a fully regulated digital therapeutic in the UK has a benchmark time of 2 years, and costs upwards of £250,000. These costs and barriers are exacerbated in premature industries. For innovators developing XR products for mental health treatment, there are several unique challenges:

• Finding a value Fit - Innovators struggle to effectively align the benefits of XR technology with the specific needs and priorities of NHS mental health services. This challenge is linked to evidence-based efficacy, accessibility, user experience, clinician acceptance, and cost-effectiveness, which must be addressed in coordination with NHS partners. Successful XR applications must provide measurable value in improving mental health outcomes, while also fitting seamlessly into existing clinical workflows and resources.‍

• Accessing testing opportunities - With an industry in such early stages, testing and validation are critical to ensure the safety, efficacy, and usability of XR solutions. Rigorous clinical trials are necessary to generate evidence for the effectiveness of solutions and to align with healthcare standards and guidelines. This process also requires syncing solutions with healthcare workflows, electronic health record systems, and clinical practice - which can be difficult for early-stage innovators.‍

• Securing funding -  Securing funding is challenging for innovators in any digital therapeutics industry, where leaders often have insufficient contact or understanding of where and how to pitch for capital. These challenges are exacerbated when adopting immersive technology solutions for mental health treatment as a lack of awareness about the potential benefits and geenral scepticism towards digital therapeutics hinders both public and private investments.‍

• Navigating regulatory approvals and security requirements - Many innovators meet a ‘cliff-edge’ when the intended purpose of the digital therapeutic they are developing is judged to be a medical device. Obtaining regulatory approval is a challenging and time-intensive process, but meeting quality management and regulatory standards is essential to ensure the safety and effectiveness for all medical devices. Additionally a capability failure exists where XR businesses have been focused on the entertainment industry and are unfamiliar with the capabilities needed to open routes to market in health.‍

• Demonstrating clinical outcomes - The belief in consumers that an XR solution will be an effective mental health treatment requires different levels of credibility and research from various NHS and non-NHS stakeholders. This requires careful early study design to demonstrate impact and generate interest and momentum to prompt at-scale adoption in the NHS and private buyers of digital therapeutics. ‍

• Developing a commercial strategy  - NHS commercial opportunities are often biassed towards large incumbent suppliers. In this context, XR innovators must navigate the complex and highly fragmented healthcare system and procurement processes, understand how to effectively work with NHS contractors and navigate the financial considerations around licensing and IP.

How can we grow the sector and support innovation?

‍Many immersive technologies for mental health treatment are at very early stages of development and therefore need strategic support to get them into clinical settings. As a result, an effective support system to ensure long-term adoption by users and frontline services within the NHS and beyond, is needed in order to grow the sector and support innovation - and there’s no shortage of potential out there. We’ve highlighted just some of the startups/SMEs that are working in this sector today in the pdf below to illustrate the range of solutions poised to scale in this market.

Below, we outline a few key actions that will support innovators in this space in the most effective way possible:

• 1️⃣ Facilitate collaboration with healthcare providers to develop and refine solutions around the best use-cases within mental health services. Only by working with patients and service providers will innovators be able to find the right fit between what is valuable, feasible and desirable. PUBLIC has demonstrated the success of this model in the health and care sector specifically, with programmes such as GovStart,  the AWS Healthcare Accelerator and TechForce19, which together have supported over 40 HealthTech startups to collaborate with healthcare providers and end-users. This model presents an opportunity to drive collaborative innovation forward in a user-centric way to create products that work well and scale effectively in practice.

• 2️⃣ Develop faster routes to demonstrating cost-effectiveness by building on the work of clinical research organisations such as IQVIA’s Appscript initiative building cost-effectiveness estimates for other novel digital therapeutics leading to NICE technology appraisals. There is no shortcut past published clinical research, and this sector is currently immature in how it approaches this.

• 3️⃣ Build a community of interest around immersive technology for mental health treatment, bringing together creative specialists, technologists, clinicians, patients and wider public involvement to connect, share intelligence and co-create. This will also support access to finance to help innovators meet investors, map funding opportunities, and pitch effectively in order to develop and scale their products. PUBLIC has experience running programmes which drive innovation and growth around a new, niche sector such as this. Through the SafetyTech Challenge Fund in 2021, we built a community of interest made up of innovators, government departments, regulators, and investors  and supported new entrants to a market with high levels of ethical concern and controversy. This is a good illustration of what can be done to create confidence in the investment market that a sector is worth investing in while supporting innovators to deliver solutions to a complex public sector market.

• 4️⃣ Enable open conversations with regulatory leaders about what is required when launching a digital therapeutic and provide tailored advice so that innovators can access the market quickly. Hardian Health provides a good example of how to achieve this, as a specialist health tech regulatory consultancy which has supported 100+ businesses, innovators, universities and technology developers in the regulation of medical devices, with a focus on software as a medical device (SaMD). Support such as this lifts the veil on how regulators categorise XR hardware and SaMDs and enable innovators to navigate regulation. 

Programmes of support which meet the key actions to grow the sector and support innovation are essential to unlock the potential of XR for mental health treatment. The UKRI funded Mindset programme - a £20m fund to invest in projects which deliver immersive digital mental health therapeutics and to create a supportive ecosystem to enable their commercialisation - has opened an opportunity to catalyse collaboration between healthcare and creative sectors, develop innovation within the UK for global wide potential, and provide urgently needed digital delivery models for mental health services. 

In order for the UKRI Mindset programme to be effective in its ambitions, support should be sought from organisations that 1) understand the digital therapeutic innovation pathway and mental health service provision, 2) know how to make commercial success from breakthrough innovation, and 3) have the ability to shape the investment landscape to make a bet on growing a new sector.