Emilia Molimpakis: using video games to assess mental health

In episode 15 of the Founders For Good Podcast, Craig Turner is joined by Emilia Molimpakis, CEO & Co-Founder of thymia.  

The current method for assessing mental health is very subjective and hasn’t changed for almost a century. When her best friend experienced depression and tried to take her own life, Emilia combined her passion for linguistics, gaming and mental health to create thymia.

Keep reading to discover...

🇬🇧 What the current state of mental health is in the UK  

🧠️  How mental health is currently being assessed (and why it’s so broken)

🕹 How Emilia is creating a new standard of mental health assessment with thymia  

What is the current state of mental health in the UK?

Emilia: I think overall everyone would agree that the number of people exhibiting not just depression, but other types of mental health disorders or conditions is growing. I think the latest metrics are that it has about a 16% compounding annual growth rate.

Unfortunately, Covid has meant that the number of people with depression has doubled outright, which is horrific if you think about it. But I think we're also seeing the result of an increased awareness of mental health.

There were probably quite a few more people in the past who had mental health issues but were either not aware of it or not being diagnosed properly. So that increases the numbers, but also just the stress of life and all the unusual and interesting events (to put it mildly) that everybody's being going through.

Not just with the pandemic, but also global warming, financial crises - the past 10 years have been exceptional in so many ways. It's bound to have an impact on people's mental health. We’re seeing the compounding effects of multiple stressors and the result is more people are experiencing mental health issues. Unfortunately, the healthcare system is not accelerating at an equal pace to be able to tackle this.

It might surprise you to find out that psychiatrist numbers are shrinking instead of growing at this point because stress does get to them as well. Plus, the job they have to do is getting worse and worse. And this is making the issue even worse overall.  

What are the issues with the way mental health is currently being assessed?

Emilia: It's important to clarify that there isn't one particular path that all countries follow around the world, or all professions follow. So that makes this a little bit more disjointed. But say we focus on assessing depression in the UK – currently, the gold standard that GPs and psychiatrists have for diagnosing and monitoring depression is basically two things:  

• They have their own observation skills, which could be better or worse depending on the clinician's expertise.
• They also have questionnaires.

Unfortunately, there isn't really anything widely available like a blood test or a blood pressure cuff, or a thermometer for depression in some way.

So really, you just have questions. To give you a concrete example, the typical questionnaire everybody uses is called the Patient Health Questionnaire, so PHQ, and there's a number at the end which indicates the number of questions.

If it’s a PHQ-9, each of these nine questions aim to target a symptom of depression, with the patient rating it on a scale of one to four. So, if I'm the clinician and you're the patient - if I suspect you have depression I'll start asking you ‘could you rate in the past two weeks, on a scale of one to four, how often you felt sad?’

So, you go through the questions and there are elements of sadness, of outright depression, questions around appetite and sleep patterns. At the end you get a score based on that number. Now, unfortunately, these questions have been found to be very subjective. It’s up to you as a patient to decide your rating from one to four. The questions are also quite leading.  

So it’s been found that people can easily manipulate these questions - so if I want medication, I will basically know what to answer. If I want to show that I'm fine, I'll know what to answer. The worst question is one that aims at suicidality and basically asks you outright, do you feel like hurting yourself or ending things?

Now, most patients have this intrinsic fear when they're faced with that question:

• A: am I going to look crazy if I say yes?

• B: what does that mean? If I say yes, am I going to be institutionalized? Is this gonna have an impact on myself and my family?  

So, you automatically say no to that question or like rank it really low. As a result, it takes an astounding 10 to 13 years to diagnose someone properly with depression and to find the right treatment for that person.  

It's a very problematic, broken system. That was the real intrinsic motivation of why we built thymia.

‍What is thymia’s solution to mental health assessment?

Emilia: With thymia, we monitor patients and assess them before, during, and after each appointment through specially designed video games.

These games aim to elicit data from three different types of streams. We switch on your microphone, your camera, and we also observe your behaviour during the game. We gather elements of your speech, your facial micro expressions, movements - twitching, eye movements etc, and then finally your behaviour in the game in terms of reactions.

This allows us to pull out more objective measures of different cognitive aspects that are affected in depression. We're trying to pinpoint the same things that the PHQ-9 is doing, but in a much more objective way. In a way that the patient can't manipulate and in a way that they don't feel cornered or scared to admit suicidality.

Want to learn more about Emilia’s journey with thymia? Listen to the full episode.