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From Death Comes Life

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“He’s braindead, there’s nothing you can do, and you must start considering organ donation.”

This is what Anzel Schoeman was told by her sister while they were flying back to South Africa.

In 2005, they were on holiday in Egypt. As she was leaving a museum in Cairo, she was told to phone her father urgently. Tranquility turned to trauma. Her husband Nico Theron had been in a motorbike accident; Schoeman took the first flight home.

At the Pretoria East Hospital, Schoeman was with the doctors when they performed a series of tests to determine whether he was brain-dead or not.

“It’s traumatic to see this but it was then I realized this is just a body lying here; the brain is not operating, it’s a machine pumping air into the body,” says Schoeman.

With this realization, Schoeman had no hesitation in agreeing to donate Theron’s organs.

“Just before I left, we had discussed the subject because my sister was a doctor. For me, it wasn’t such a struggle to make the decision, [I didn’t have to wonder] ‘would he have wanted this?’ ” she says.

When a person dies, their heart, lungs, pancreas, kidney and liver can be used to save up to seven lives, according to the Organ Donor Foundation of South Africa (ODF). In addition to that, up to 50 people can be helped with tissue donation. The eye’s corneas, skin, bone, tendons and heart valves are used for this.

Schoeman agreed to donate most of Theron’s organs, but the doctors couldn’t use his lungs because of the scar tissue that formed during the trauma. The organs need to be harvested as quickly as possible to increase their effectiveness during the transplant process. Amid the trauma, and with little time to come to terms with what had happened, Schoeman made a sentimental decision.

“At that stage, I didn’t want to give his corneas because he had the most beautiful light blue eyes. I just couldn’t get over myself to say yes for the eyes.”

South Africa has a proud history in organ donation. Dr Christiaan Barnard performed the world’s first human-to-human heart transplant at the Groote Schuur Hospital in Cape Town in 1967.

Unfortunately, that legacy is not being lived up to today.

“We have one of the lowest donor per million population rates; we have 1.8 donors per million population,” says Samantha Nicholls, the Executive Director of ODF.

“There is a critical shortage of organ donors in South Africa. Currently over 4,300 adults and children are awaiting a life-saving transplant and less than 600 transplants are performed annually. Many patients can wait years for a transplant and many die waiting as a result of this shortage,” she says.

There are a few reasons for this shortage, says Nicholls. These include a lack of awareness, religious and cultural misconceptions, and a lack of urgency.

“People do not realize the great need and do not want to think about their own death and the gift they could give through their death. They think it will never happen to them, some think organ donation is unnecessary because they are fit and well, and they do not consider those who are affected by organ failure,” says Nicholls.

Mercy Or Monster?

Two women who are acutely aware of South Africa’s dire need for more organ donors are Annette Otto and Lizette Cooke. As Procurement Co-ordinators – for healthcare company Netcare – they work with organ donors every day.

They need to assess the patient to see if they are a possible candidate. They then need to talk to the patient’s family to see if they would like to donate. If the family agrees, the procurement co-ordinators do assessments, such as blood tests and x-rays, to determine the functionality of the organs. Once all this is done, they need to refer with everyone else involved in the process to decide who’s going to use what.

It’s a long and emotional process.

“It’s a body lying on a bed on machines and there’s a heartbeat and all the organ functions are there. It looks like this person is sleeping and you have to go and convince the family that this person is dead. Only when they understand that he’s dead can you talk to them about organ donation, otherwise they think you’re going to kill him to get his organs,” says Otto.

The World Trade Organization estimates that 5% to 10% of organ transplants around the globe are done so illegally. In South Africa, between 2001 and 2003, 109 illegal kidney transplants took place at St Augustine’s hospital in Durban.

An Israeli organ-broking syndicate allegedly brought paying Israeli citizens in to South Africa, where they would receive a kidney from willing sellers for $120,000.

“I’m not aware of any incidents of illicit trade… It’s difficult to police, these things can happen. What we can’t account for is illicit trade in human organs for uses other than transplantation; for medicinal uses in the communities, for body parts being stolen from mortuaries. That I’m sure happens. But from a transplant perspective, we have organ registers of what transplantation happens around the country and we look out for this type of thing,” says Professor Jerome Loveland, the Head of Paediatric Surgery at Chris Hani Baragwanath Hospital, in Soweto, and the President of the South African Transplantation Society.

To help prevent trafficking, two independent doctors have to verify that a person is dead before organs can be harvested. Schoeman took part in this process when her husband died.

“Before this, his hands would twitch and I’d call the doctors and tell them. But they said, ‘No, the brain is trying to send impulses to the body but nothing is happening’,” says Schoeman.

“There are various tests they do. One of them is called the doll’s eye where they keep the eyes open and move the head from side to side. If there’s brain function, your eyes will try to focus on something as they turn the head, and there was nothing. The other one is they prick them with needles on their knees and underneath their feet and watch whether they flinch. Another one is taking them off the oxygen and see if they want to inhale. These things are instinct, you can’t control them,” she says.

Anzel Schoeman (Photo by Motlabana Monnakgotla)

Otto’s first case was helping Schoeman through the process of organ donation.

“Annette and them came and explained the benefits of organ donation. They don’t switch off the machines because they want the organs. They’re not like vultures sitting there waiting. They keep you calm and updated,” says Schoeman.

It can be a delicate process.

“The family has to have time to absorb everything you tell them. You can’t give them all the information and then say you need a decision. You have to step back and let them do what they need to do,” says Cooke.

“We help them make a decision, at a difficult time, that is right for the family. Organ donation is not always the right decisions for a family, especially with different cultures,” adds Otto.

“I was dealing with two young men who lost their sister and they knew about organ donation but one of them said we have a problem because he had to speak to the elders. He said I know my sister would have wanted to donate organs but when I speak to the elders they’re not going to understand this. So he had to decide whether he continues and doesn’t tell the elders, or is he going to talk to the elders,” says Otto.

“The younger generation is open to organ donation but the older generation isn’t. If he had gone ahead with the donations he could be extricated from the community,” says Cooke.

Although Otto and Cooke’s job is to find organs that could save someone else’s life, there is an ethical line they can’t cross.

“I had boys who wanted to donate organs but they hadn’t included their grandmother, who raised them, in the decision. They said she would say no but I had to tell them to speak to her. She needed to be part of the decision,” says Otto.

“It’s the same if someone says they only want to donate kidneys, you can’t use the rest of the organs. One girl said we can’t use her dad’s eyes or his heart. She said he looked at me with his eyes and he loved me with his heart. The other organs we could have but the eyes and heart were emotional to her.”

It’s not only an emotional time for donors. Thousands of people in South Africa are anxiously waiting for an organ.

“I’ve also been with people who are on the list waiting for organs… They sit and wait for somebody to die. For them to mentally get past this [guilt] of wanting somebody to die so they can live – I tell them it’s ok to ask, because it’s ok for us who are left behind,” says Schoeman, who works as a volunteer for ODF.

The Waste Of Doctors Waiting On Tables And Answering Phones

Being on this list doesn’t guarantee you’ll get an organ.

“The first thing you have to take into account is blood group compatibility. The next question is who is the sickest patient on the list. It is tailored by the size of the organ, so the height and weight of the donor come into the decision-making process. You can’t put an adult’s liver into a five-year-old. Last Saturday, the sickest patient was a 19-year-old woman with an auto-immune disease and she got the liver. However, access to a transplant unit is different. If you’re living outside an urban area, and the same applies if you’re not on a medical aid, your access to a transplant center is not as easy,” says Loveland.

Loveland often has to travel with the organs on a commercial plane as they are transported from the donor in one city to the recipient in another. He keeps the organ in a cooler box on his lap during the flight.

“They need to be kept cold. When we harvest organs, we instill a cold preservative fluid into the organs to preserve them and bring down the metabolic rate. It allows us an opportunity to keep the organ out of the body but that time is very limited. For a kidney, you’ve 24 hours as your cut-off but for a liver you’re looking at eight hours. The sooner we can get them where they need to be the better,” he says.

In many cases in South Africa, those that need organs don’t get them.

“If a patient dies while waiting for an organ it is devastating. It’s part of the reality; you’re working with death all the time,” says Cooke.

Cassie Walkers, a former policeman, was fortunate enough to get a kidney from his daughter, Philna, in October 2016. Emotion floods through him as he talks about having to take an organ from his child.

“It’s a big thing; but I had to decide [between taking my daughter’s kidney or] to go on like that and die within two or three years, you can’t go on dialysis forever… I knew my chances weren’t good, to get an organ with the right blood type and at my age, there was almost no chance,” says Walkers.

Walkers has polycystic kidneys. He says when the doctors removed his kidney it was as big as an ostrich egg and weighed 14kg.

“I was in hospital for three weeks to take the kidney out,” he says. He creates a rugby ball sized shape with his hands to show the hole they had to cut in his abdomen.

“They had to take it out in pieces.”

Cassie Walkers (Photo by Motshodi Disemelo)

His life has changed dramatically since the transplant.

“It’s unbelievable. I’m living again. Within the next three or four weeks I’m going to play golf again… I haven’t played for 10 years because I wasn’t able to hold a club,” he says.

Because it was his daughter, Walkers knows who he got his kidney from. Donors that aren’t family need to be kept anonymous.

“An organ donor and their family have just made a massive decision and they need to be alone in that. You don’t need seven, eight or nine families harassing them, even if it’s to say thank you. Also, it’s up to us medical practitioners to decide what organs are suitable to use and how to use them. It’s not for the patient to then go and say ‘I’m 23, why did you put a 44-year-old’s liver into me?’ ” says Loveland.

Accidentally, Schoeman has met one of the recipients of Theron’s organs. She gave a speech at a tribute day attended by families of donors and recipients. She told her story and mentioned the date of Theron’s death, which triggered the curiosity of a particular family.

“This lady came up to me. I could see she was very nervous. She was asking me questions about my husband and eventually I said ‘ma’am, what do you want to ask me?’ She kept quiet and her husband was standing next to her and then she said, ‘you know what, my husband has your husband’s kidney’. The tears just started flowing and eventually his two sons came to me and just stood there; they couldn’t talk to me. The one eventually said ‘I’m a lawyer, I know how to use words, that’s my business, but the only words I can say to you is thank you because my dad is still alive’,” says Schoeman.

While talking to FORBES WOMAN AFRICA about this, tears start streaming down her cheeks.

“For me, it was nice to meet them and see this person doing well. There was nothing like me seeing something of me, or my husband, in this person. There was no such feeling. I was just so overjoyed that this father still had their father and grandfather.”

She says after Theron’s organs were harvested and the recipients were prepared, her own process of healing started and it helped to know she had helped someone else.

“I had this peace of mind to give. By giving you’re helping so many others.”

As Walkers finally walks on a golf course again, he will understand this more than most.

Health

Cure For Counterfeit Drugs?

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Blockchain technology is also revolutionizing supply chains in the pharmaceutical industry, in the process, helping track fake medicines.

From genomics to robotics, technology is truly revolutionizing the healthcare sector. And while it’s easy to become consumed by exciting, futuristic trends like artificial intelligence (AI) diagnosis, digitized patient records and 3D-printed medical tools, technology is also transforming the pharmaceutical industry. How medication is prescribed, dispensed and administered is big business with McKinsey predicting the value of Africa’s pharmaceutical industry to be $65 billion in 2020.

But fake drugs are an ongoing and complex issue – they can cause death, have unknown side-effects, fail to treat illnesses, and sometimes even add to the spread of disease. According to World Health Organization (WHO) statistics, 42% of detected cases of falsified (or substandard) pharmaceuticals occur in Africa – reports estimate that between 72,000 and 169,000 children die each year from pneumonia because of counterfeit antibiotics while fake malaria drugs cause an additional 64,000 –158,000 deaths every year in sub-Saharan Africa. Both antimalarials and antibiotics sit among the most commonly-reported counterfeited drugs.

“Fake medicine distribution is rampant because business processes are siloed between the various industry stakeholders, which puts the industry at risk of fraud,” explains Heidi Patmore, a marketing consultant specializing in technology that’s changing consumer behavior.

“One solution to this would be cross-company process automation which could easily be enabled by a blockchain data interchange. This creates an open information system that all players can use to verify the authenticity of medication because it can track and trace it from when it’s manufactured to when it is dispensed to the patient.”

Companies such as IBM and SAP are working on blockchain solutions to weed out Africa’s counterfeit medication network. When medicine is returned to pharmaceutical manufacturers, for example, it is often re-sold instead of being destroyed. How can a small local pharmacy ensure what is returned is authentic? SAP are working with their existing client base – Merck, GSK, Ingelheim, McKesson and others – on a blockchain project to verify that any returned drugs are original.

IBM Research’s solution for Africa (currently in development in Haifa, Israel) includes a mobile interface and permissioned blockchain backend that enables each certified and authorized party in the network to initiate action, finish their transaction, and track its progress.

“It also includes the monitoring of temperature to ensure compliance with the proper conditions for transportation and asset transfer,” adds Inna Skarbovsky, a blockchain architect from IBM Research – Haifa. “Blockchain ensures full provenance for each medicine package, uniquely identified with a barcode or a serial number. This makes it possible for all authorized parties to track the drugs through the entire supply chain and the drugs’ life-cycle.”

This also allows significant cost reductions by eliminating each participant’s need to manage a separate system for traceability of its components. “It also improves procedural efficiency for change-of-hands, make it much harder for counterfeit drugs to be introduced into the supply chain and to be distributed to end-users,” says Skarbovsky.

Towett Ngetich, CEO of Uthabiti Health, a Kenya-based pharmaceutical company

Towett Ngetich is the CEO of Uthabiti Health, a Kenya-based pharmaceutical company that has implemented blockchain to bring transparency and accountability back to a country where statistics show that 30% of medicines sold are counterfeit. Uthabiti, which means ‘verify’ in Swahili, was started after Ngetich’s first-hand experience with the effects of fake health products: “Back in university, a significant number of students fell victim to unplanned pregnancies and unsafe abortions. With deep research, it was uncovered that there had been a supply of fake contraceptives and backstreet abortion pills into the student market,” explains Ngetich. More findings showed the presence of fake antibiotics, antiretrovirals (ARVs) and non-communicable diseases (NCD) medicines in the Kenyan pharmaceutical supply chain.

“Pharmaceutical science is the center of healthcare – one mistake in any drug composition or formulation has the risk of endangering a significant number of people. The need to access safe, affordable and quality health products in its simplest form means life and death in diagnosed health complications. Blockchain gives patients the ability to track and trace products using attached IDs – it also gives Uthabiti Health the ability to know where all our health products sit within each supply chain,” he says. Uthabiti Health procures medicines from different pharmaceutical manufacturers. Once received, they go to an internal laboratory for quality testing and are then labeled with the product’s safety lab report – attached in their codes is a unique blockchain ID. The medicines are then passed on to their partnering retail points, ensuring that the medicines dispensed to patients can be verified with something as simple as a text message.

“This brings in consumers in safe-proofing the supply chain of pharmaceuticals,” adds Ngetich.

The proliferation of fake drugs throughout Africa is complex – on average, medicine changes 30 hands before reaching the destined pharmacy – but blockchain technology has great potential to help stop counterfeit medicine distribution because it brings traceability and trackability to the entire pharmaceutical supply chain, ensuring the immutability of information. 

Blockchain ethics?

Candice De Carvalho

While blockchain is still a relatively niche technology, it is slowly changing how organizations operate. Blockchain promises better security and transparency, but not necessarily for the customer, in the case of drug allocation: “Where blockchain technology could likely increase efficiency and simultaneously decrease the abuse of medicines, customers benefit. The pharmaceutical and related industries are unique however, in that the ‘consumer’ is also a patient – a vulnerable group with special needs and rights,” explains Candice De Carvalho, the founder of Easy Ethics CPD.

Although overall transparency in the supply chain increases through the use of blockchain, and this confers patient benefits, these must be weighed against patient privacy and confidentiality. 

“With emerging technologies more freely available, we’ve observed an interesting shift in patient behavior, where data privacy is regarded less as an absolute by patients, in favor of a kind of sliding scale, where privacy itself is a currency that purchases medical benefits along the way,” adds De Carvalho. “Patients, for the right benefits, are perhaps more willing to part with some privacy privileges.”

De Carvalho questions the genuine knowledge that patients have of any exposure they experience through their use of novel medical device or systems innovations. The key drivers for the business are not necessarily unified with the total needs of the patient. However, the more the technology owners protect and balance the patient’s need for confidentiality and consent, the more they will ultimately see business benefit. 

“In the context of a doctor-patient relationship, the doctor has a positive duty to enhance patient understanding so that the patient enjoys a truly informed consent. Does this then mean that technology providers are now responsible in the same way that medical health workers are?” she ends.

-Tiana Cline

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Agriculture

Green-Sky Thinking

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In Johannesburg, city-dwellers like Linah Moeketsi have taken the future of sustainable farming into their own hands. Where land is becoming scarce, they look to the skies.


Doornfontein is one of Johannesburg’s older inner-city suburbs with decaying buildings and dingy alleys that wear a dour, monochrome look.

Daily commuters and street surfers jostle with delivery vans and mountains of metal scrap but the grey of the concrete city makes it hard to believe that there could be a patch of green in a most unlikely location.

READ MORE| No Seat At The Global Table For Indigenous African Cuisine

Above the humdrum of life here is a rooftop hydroponics farm looking down on the city, but upwards to a new route to restoration and urban preservation.

Atop the eight-floor Stanop building – offering a breath-taking view of the city and the landmark Ponte Towers in the distance – one woman has made it her mission to turn a grimy grey terrace into a green lung on the city’s skyline.

“City life is taking on a totally new direction… even people who think they couldn’t one day farm, find themselves on rooftops,” Linah Moeketsi tells FORBES AFRICA.

Moeketsi grows herbs, used to treat non-communicable diseases (NCDs), in a 250m x 500m greenhouse on the building’s terrace. But her rooftop farm is sans any soil – it uses a hydroponics system.

“I think because we are in the city and we would like to produce for people in the city, hydroponic farming is one of the answers because you can actually harvest more than twice the produce, and the growth rate is quicker and there is produce that you can have throughout the year that people demand because it is in a controlled environment,” she says.

On a windy Wednesday morning in October, we meet Moeketsi at her aerial green facility, a couple of days before she is to send some of her plant produce to the market.

She talks about her journey as an offbeat farmer. It all started when her father fell ill in 2013, when doctors failed to correctly diagnose his disease.

“They couldn’t see that he was diabetic. He didn’t show the signs of diabetes, but he had this foot ulcer that just wouldn’t go away,” she says.

“The future of city farming is great simply because we have more and more young people getting into this space. Even though it’s farming, they are looking at it from a very different angle.

Moeketsi decided to do her own research, so she read up books on African medicinal plants and used some herbs that belonged to her late mother, who had been a traditional healer.

“It took me a good eight months to help my dad and I actually saved him from having an amputation.”

The news of Moeketsi curing her dad’s diabetes using herbs spread. Sadly, her father died in 2016, at the age of 87. But she is proud to have helped prolong his life.

“So he passed away in his sleep, not sick, nothing, he was just old. But he was always grateful; he was like, ‘even when I die, I’m going to die with both my limbs’, so we would make a joke about it.”

READ MORE| Businesses At The Heart Of A Greener Future

After her father’s demise, Moeketsi rented some land and turned her knowledge on natural herbs into a fully-fledged farm. However, when the owner of the land returned, she was forced to vacate.

Land was always going to be a problem in the city. But instead of giving up, Moeketsi looked to the skies.

“Because of this passionate drive for an answer, I found myself researching what’s happening outside Gauteng and South Africa, and I saw in Europe, they were farming on rooftops,” she says.

In 2017, her dream became a reality when she secured a deal with the City of Johannesburg as part of an urban farming program, and started the rooftop project a year later.

When we visit her greenhouse, we are welcomed by the sweet lingering scent of herbs. It’s hot and humid, and two fans whir away to cool the air.

Moeketsi walks around the greenhouse wearing dark glasses and a white jacket, with a syringe in hand – she could easily pass off as a medical doctor.

She elaborates on the hydroponics system. There are four pyramids, each attached to their own reservoirs of water. On each pyramid, different plants, ranging from spinach, lettuce, sage, parsley, basil and dill, rest on beds with pipes connecting them to the reservoirs. Moeketsi plucks out one of the pipes and inserts the syringe; water spouts out of the tube and she returns it to the bed.

“Twice a day, you have to check that water is actually going through the pipes, because that’s how the plants get water and nutrients,” she explains, as she unblocks a pipe using the syringe. She says it’s one of the best ways to farm using little water.

“When you put in certain plants in the greenhouse, you know you are guaranteed sustainable farming because you can produce those plants and harvest them,” she says.

Moeketsi adds that this allows her produce to stay consistent season after season.

“So, from that point of view, it makes the city more sustainable in terms of food produce that is easily accessible and cost-effective for the consumer because not everyone around here can afford the high prices of food but they can at least afford what we sell, whether it is at R10 ($0.5) or R15 ($1).”

As Moekesti continues to tend to the plants, a farmer she works with walks in and begins filling up the reservoirs.

Lethabo Madela has known Moekesti for almost six years.

“When you look around Johannesburg, there is no space, so rooftops have saved us a lot, especially those of us that love farming,” says Madela. “I’m learning a lot and I think she [Moekesti] changed the whole concept of farming for me because I used to farm vegetables. I didn’t know culinary herbs or medicinal herbs.”

Moeketsi speaks of other farmers around the city who have taken to the rooftops to farm plants such as strawberries, lemon balm, spinach and lettuce.

READ MORE| Everything You Need To Know About The Future Of Pesticides And Bees

In a suburb called Marshalltown, a 10-minute drive from Moeketsi’s farm, Kagiso Seleka farms lemon balm also using hydroponics.

He produces sorbet and pesto from his produce which is then used to make ice cream.

“It [hydroponics] is great for farming sensitive plants in terms of temperature. Lemon balm does not like frost. But it’s better to grow even out of season so you can set a higher price,” he tells us.

However, he says hydroponics farming is a luxury not many farmers can afford.

“It [hydroponics] does have a bit of a higher capital upfront, but you get a higher yield and higher quality, so people are willing to pay more. Hydroponic planting saves about ninety five percent of water soil farming in a water-scarce country,” says Seleka.

READ MORE| Local Solutions Can Boost Healthier Food Choices In South Africa

“We do have water shortages, and I know people are on the whole ‘organic trip’ but, is it more important to have an organic plant versus a water-saving environment?”

The Program Coordinator for Agriculture at the City of Johannesburg’s Food Resilience Unit, Lindani Sandile Makhanya, says there certainly are more rooftop farmers in Johannesburg now than ever before.

Converting idle terraces into avenues of profit is becoming a norm. There are new rooftop farms being set up every day, offers Makhanya.

He regularly visits Moeketsi’s farm to check on the progress and collect produce to sell.

“Urban farming in Johannesburg is rising, mainly because the idea of producing our own food is very important because most people are moving to urban areas and therefore it stands to reason that we have to try to produce as much as possible,” says Makhanya.

“[There is growth] even in animal production, although we are moving away from the bigger numbers, but we are involving the smaller ones; because of the space issue, they are increasing overall.”

For Moeketsi, her farm has changed her life and given her hope for a better future. In addition to the teas, tinctures, ointments and medicinal products she processes from her plants, she plans to include more by-products such as syrups in the future.

“The future of city farming is great simply because we have more and more young people getting into this space. Even though it’s farming, they are looking at it from a very different angle,” she says. “That is why the city is changing and rooftop farming is going to get bigger and bigger.”

Clearly, farming in Africa is covering exciting new ground.

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Health

How Virtual Therapy Apps Are Trying To Disrupt The Mental Health Industry

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Millions of Americans deal with mental illness each year, and more than half of them go untreated. As the mental health industry has grown in recent years, so has the number of tech startups offering virtual therapy, which range from online and app-based chatbots to video therapy sessions and messaging. 

Still a nascent industry, with most startups in the early seed-stage funding round, these companies say they aim to increase access to qualified mental health care providers and reduce the social stigma that comes with seeking help. 

While the efficacy of virtual therapy, compared with traditional in-person therapy, is still being hotly debated, its popularity is undeniable. Its most recognizable pioneers, BetterHelp and TalkSpace, have enrolled nearly 700,000 and more than 1 million users respectively. And investors are taking notice.

Funding for mental health tech startups has boomed in the past few years, jumping from roughly $100 million in 2014 to more than $500 million in 2018, according to Pitchbook. In May of this year, the subscription-based online therapy platform Talkspace raised an additional $50 million, bringing its total funding to just under $110 million since its 2012 inception.

The ubiquity of smartphones, coupled with the lessening of the stigma associated with mental health treatment have played a large role in the growing demand for virtual therapy. Of the various services offered on the Talkspace platform, “clients by far want asynchronous text messaging,” says Neil Leibowitz, the company’s chief medical officer.

Users seem to prefer back-and-forth messaging that isn’t restricted to a narrow window of time over face-to-face interactions. At BetterHelp, founder Alon Matas notes that older users are more likely to go for phone and video therapy sessions, whereas younger users favor text messaging.

“Each generation is getting progressively more mobile-native,” says John Prendergass, an associate director at Ben Franklin Technology Partners’ healthcare investment group, “so I think we’re going to see people become increasingly more accustomed, or predisposed, to a higher level of comfort in seeking care online.”

The ease and convenience of virtual therapy is another draw, particularly for busy people or those who live in rural areas with limited access to therapy and a range of care options.

Alison Darcy, founder and CEO of Woebot, a free automated chatbot that uses artificial intelligence to provide therapeutic services without the direct involvement of humans, says that with Woebot and other similar services, there is no need to schedule appointments weeks in advance and users can receive real-time coaching at the moment they need it, unlike traditional therapy. The sense of anonymity online can also lead to more openness and transparency and attracts people who normally wouldn’t seek therapy.

Along with stigma, the cost of therapy has historically acted as a barrier to accessing quality mental-health care. Health insurance is often unlikely to cover therapy sessions. In most cities, sessions run about $75 to $150 each, and can go as high as $200 or more in places like New York City. Web therapists don’t have to bear the expense of brick-and-mortar offices, filing paperwork or marketing their services, and these savings can be passed on to clients. 

BetterHelp offers a $200-a-month membership that includes weekly live sessions with a therapist and unlimited messaging in between, while Talkspace’s cheapest monthly subscription at $260-a-month, offers unlimited text, video and audio messaging.

But virtual therapy, particularly text-based therapy, is not suitable for everyone. Nor is it likely to make traditional therapy obsolete. “Online therapy isn’t good for people who have severe mental and relational health issues, or any kind of psychosis, deep depression or violence,” says Christiana Awosan, a licensed marriage and family therapist. 

At her New York and New Jersey offices, she works predominantly with black clients, a population that she says prefers face-to-face meetings. “This community is wary of mental health in general because of structural discrimination,” Awosan says. “They pay attention to nonverbal cues and so they need to first build trust in-person.”  

Virtual therapy apps can still be beneficial for people with low-level anxiety, stress or insomnia, and they can also help users become aware of harmful behaviors and obtain a higher sense of well-being. 

Sean Luo, a psychiatrist whose consultancy work focuses on machine learning techniques in mental health technology, says: “This why some of these companies are getting very high valuations. There are a lot of commercialization possibilities.” He adds that from a mental health treatment perspective, a virtual therapy app “isn’t going to solve your problems, because people who are truly ill will by definition require a lot more.”

Relying on digital therapy platforms might also provide a false sense of security for users who actually need more serious mental-health care, and many of these apps are ill-equipped to deal with emergencies like suicide, drug overdoses or the medical consequences of psychiatric illness. “The level of intervention simply isn’t strong enough,” says Luo, “and so these aspects still need to be evaluated by a trained professional.

Ruth Umoh, Diversity and Inclusion Writer, Forbes Staff.

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