Oskar is leveraging the Norwegian healthcare system to attend to currently underprioritized patients with mild and moderate symptoms of the most common mental health disorders. By also developing a web-based platform for experts to create and share treatments, Oskar is building a library of interventions, spreading knowledge about mental health and opening up for new types of collaborations within the healthcare system.
The New Idea
With Assisted Self-Help (ASH) tools, Oskar aims to improve the access to affordable treatments among patients who experience mild and moderate symptoms of the most common mental health disorders, such as depression, anxiety and sleeping disorders. Oskar is leveraging the Norwegian public mental healthcare system by making web-based ASH treatments available for general practitioners (GP) and mental health experts to attend to patients with mild/moderate mental health problems who are currently underprioritized due to lack of resources. Oskar provides a faster response for this large number of patients, thus improving their quality of life. Simultaneously he addresses the issues of an inefficiently structured and overcrowded healthcare system.
Oskar seeks to create a system where people can quickly get the relevant support they need to treat emerging mental health problems. To achieve this, he is building an author tool based on creative commons principles for mental health experts. With the author tool, specialists can contribute content to web-based interventions in their areas of expertise, allowing them to learn from and build on each other’s practices as well as spreading these interventions to an unlimited number of individuals within specific target groups. Oskar is building connections and ultimately lowering barriers for collaboration across health providers from different areas of expertise, such as psychology, cardiology and general practice. Finally, he is addressing the inefficient structures of the healthcare system and fractured treatment and diagnoses processes by facilitating collaboration between experts, producing knowledge and ultimately saving valuable resources and money in healthcare institutions across the country.
Given the global rise of common mental health disorders, as well as the limited resources of public healthcare institutions and the lack of spaces of collaboration across different areas of expertise, Oskar’s idea could help millions of patients and healthcare workers worldwide.
The Norwegian Institute of Public Health (NIPH) reports that nearly 40% of the Norwegian population suffer some form of mental health problem during their lifetime – different stages of depression, anxiety and ailments related to substance abuse are the most common disorders. Approximately 50% of these patients do not receive any professional help in Norway, which indicates a significant treatment gap. Despite of the efforts of the Norwegian government to improve mental healthcare, the efficiency of the services is hindered by stigmatization, alongside structural issues such as long waiting times, high thresholds for consulting mental health experts and reluctance to receive face-to-face treatment in a clinical environment. Statistics from the NIPH show that in 2008 approximately 10% of the adult population in Norway contacted health services for mental help, but only 3% received treatment between 2008-2012.
Norwegian public mental healthcare system is designed in a way that patients need to consult a GP in order to get initial diagnosis. Depending on the symptoms, patients with severe conditions are qualified to consult a mental healthcare expert, while those with mild and moderate disorders tend not to get a referral from their GP. GPs are expected to work individually to diagnose patients without a collaborative support system, and often times they are obliged to dedicate only a few minutes to each patient. The constrained resources of the public mental healthcare services hinder the implementation of effective follow-up programs for patients with mild and moderate disorders, causing patients who did not qualify to meet an expert on the first try to usually seek a second opinion, using more resources from the healthcare system. Even if GPs suggest booklets or websites that contain standard information on mental health disorders, this approach does not hold patients accountable for their own treatment. As GPs are not allowed to refer mild cases to experts, this vicious circle created by non-referred patients causes GPs to falsely escalate the patients’ conditions to ‘severe’ so that they can consult mental health experts and get treatment. Because of this process, the waiting time for the referred patients can rise up to 12 months before they see an expert within the public healthcare system, leaving no other option but waiting for those who are not able to afford to consult private practitioners.
It takes approximately 17 years for clinical research findings to be implemented in practice, which is even longer in the case of disorders that require interdisciplinary collaboration between specialties for diagnosis and treatment (e.g. psychology and cardiology). The current siloed approach and the inefficiencies of the healthcare system hinder collaboration between experts, which in turn limit patients’ access to diagnosis and relevant treatments. For example, patients suffering from non-cardiac chest pain (NCCP), which is a condition can be caused by panic-attacks, generally go undiagnosed. Since these patients usually head to cardiology units with chest-pain complaint, in the majority of cases they get neither diagnosed nor treated due to lack of input from a psychologist, resulting in lower quality of life. Furthermore, on average, 15% of the NCCP patients are on sick leave, generating an annual cost of more than 10,000 EUR per patient in welfare institutions.
According to the World Health Organization (WHO), over 300 million people around the world suffer from common mental health disorders (e.g. depression, anxiety). The organization estimates depression to be the leading contributor to global burden of disease by 2030, which makes the topic crucial on a global scale.
Oskar is improving the quality of health services by integrating ASH tools into municipal healthcare system. He targets patients with the most common mental health disorders (e.g. depression, anxiety and sleeping disorders) on a mild/moderate degree, who are not prioritized due to the over-capacity of the system. Oskar’s web-based ASH treatments provide professional support to these patients with evidence-based, informative and easy-to-implement tools, allowing them to take charge of their own therapies. The practitioner’s role changes to a supervisor who controls the improvement of the patient on a weekly basis rather than providing the treatment itself, which reduces the overload on healthcare workers. Oskar’s preventative approach also addresses the long waiting times for mental health treatments, often responsible for worsening the patient's condition. With ASH, Oskar expands patients’ support network beyond outpatient clinics and breaks their dependency cycle on mental health experts, benefitting both patients and experts. Through ASH, patients gain overall knowledge about their disorder, which helps them to normalize their symptoms and view their situation in a more positive light, creating a sense of trust and security. Experts who introduce ASH tools to their patients are enabled to use their time more efficiently and reach more patients, thanks to reduced waiting times.
Secondly, Oskar addresses the problems of siloed healthcare structures and lack of interdisciplinary collaboration between specialties, which makes it difficult to address certain cases. He provides an author tool to mental health experts of various specialties – which is an online platform for healthcare experts to create specific content for web-based treatments. The platform is based on creative commons principles, which means that an expert can freely use modules from other treatments on the platform to create a new intervention for a different mental health disorder or a target group (e.g. using modules for common depression treatment to create a specific content for depression among ovarian cancer patients). Oskar also makes the author tool available for clinical research projects and health providers to adapt to their own target groups and increase their outreach and impact. This approach allows different health providers to reuse and share treatment modules with each other instead of recreating the content from scratch – decentralizing the knowledge, saving resources and increasing access to different patient groups. As a psychologist, Oskar personally checks the content of each intervention to ensure the quality standards are met before they are made available for patients. Moreover, he recruits only mental health experts as content creators, registering them with their healthcare license number to secure the authenticity of the person. Oskar continuously incorporates expert and patient feedback to improve the quality of treatments, making them more adaptable and engaging for different user groups.
In order to showcase the benefits of his collaborative approach within healthcare system, Oskar has put his solution into use for clinical studies in the Hospital of Southern Norway in Kristiansand, Norway. Psychology and cardiology departments work together on patients with NCCP syndrome, who are often neither diagnosed nor treated, much because of lack of collaboration between the two disciplines. After the positive results from the initial pilot study, the hospital currently uses Oskar’s solution to treat 160 NCCP patients as a part of clinical study, and they are aiming to spread the practice to other institutions across Norway.
Oskar’s platform contributes to the generation of knowledge and new methods, innovating the mental health field. ASH treatments created by experts using the author tool do not only rely on cognitive behavioral therapy, which is the most commonly used method among web-based mental health treatments, but also incorporates other clinically-proven methods, such as meta-cognitive and acceptance-commitment therapies. By mixing these methods, Oskar introduces new techniques, making his preventative approach flexible – as opposed to pushing fixed standardized programs to all patient groups. As the library of web-based interventions develops, Oskar aims to create a peer-review system where experts can examine other treatments and give opinions, ensuring quality while also improving learning and establishing best practices.
Oskar designed a cryptography solution where the patients’ data is logged as randomly generated codes – this anonymous use of data makes the patients’ identity untraceable together with the treatment record, encouraging more healthcare providers to use the solution. Throughout Europe, healthcare systems are set up very differently across countries. Oskar’s solution is easy to implement by practitioners within public healthcare services regardless of the system used, since it is used alongside the medical journal systems. To date, 28 municipalities across Norway have adopted ASH tools as a part of their public mental healthcare system, which is offered to more than 1,500 patients per year. Oskar is increasingly receiving requests from various healthcare providers who are keen to reach their target groups (e.g. ovarian cancer patients with depression) by using his solution. This growing demand is triggered by the successful results and outreach to more than 7,000 patients, thanks to the partnerships Oskar has formed with municipalities, Norwegian Blue Cross and AKAN (a partially public organization helping leaders and employees to handle drug use and addictions in the workforce). More treatment modules are currently being developed by the experts, using Oskar’s author tool to address different issues, such as obesity, burnout, substance abuse among teenagers, as well as a treatment to help doctors in assisting patients to reduce the use of Benzodiazepine based medications – which is one of the main components of drugs used against sleeping disorders and anxiety. Following the interest of Wayne State University, Detroit/USA, in developing a treatment against hospital-induced opioid addiction caused by overprescribed painkillers, Oskar will visit the United States in June 2018 to explore long-term collaboration possibilities to expand his solution internationally.
Having always been interested in technology, Oskar taught himself programming early in his youth. After trying a range of study areas as an undergraduate student, including data programming, Oskar understood that his passion lies in psychology and in helping people. He applied to a highly competitive psychology program four times until he got admitted. As a research assistant during his studies, he created a program to analyze the recurrent research data in his project. He identified that many other researchers could benefit from this solution if it was web-based, which led him to create the website that later became Explorable.com in 2008. As the site includes concepts, tools and research about psychology, it became part of university courses and it is still has 1,5 million users each month, mainly by students, researchers and healthcare professionals – reaching more than 80 million people globally up to this date.
After completing his studies, Oskar started to work as a psychologist within the Norwegian public healthcare system. As a practitioner at an outpatient clinic, he saw the constrained resources of the mental health workers and the limited capacity for a more effective diagnostic and treatment process. Initially, he mobilized his colleagues and, with the support of his supervisor at the hospital, he introduced a program targeting patients waiting extended periods of times to consult a mental health expert. As a part of this program, Oskar and his colleagues introduced general concepts about mental health problems to their patients and empowered them with positive techniques, instead of letting them passively wait until they were assigned to consult an expert. Growing frustrated with the limitations and lack of innovation within the health system, Oskar decided to combine his skills in technology with his insights and expertise as a psychologist to come up with ASH tools and the author tool that exists today. This initiative is mainly financed by Explorable.com, which he also developed. Having a global vision, Oskar seeks to help many other patients in need in other regions, as well as triggering innovation in mental health treatments.