It’s a worldwide problem, and countries are looking for innovative ways to address it – and one way is using digital technology. The hope is that smartphone apps, websites, virtual-reality and augmented-reality goggles and other modern gadgets can not only help to prevent mental health problems from developing, but also stop them from escalating, says Iris Elliott, head of policy and research at the Mental Health Foundation charity.
The argument goes that people suffering from mental distress who are busy at work or with their families and social life might prefer an online option. The same could apply to people living in isolated locations or those not too keen to visit a doctor.
“Traditional face-to-face therapy with a mental health professional is important, but it doesn’t suit everyone,” says Elliott. But could technology – in some cases – be contributing to mental health issues, rather than treating them?
At first glance, users do seem to benefit. Tim Matthews turned to the No More Panic website to help him understand his anxiety when it first hit. It worked so well that he says he doesn’t need to use it any more. Joanne Ryder (name changed to protect identity) says that getselfhelp.co.uk helps her collate her thoughts and consider them in relation to a particular challenging situation.
Using apps
Wendy Hemsworth says that digital services enable her to access advice, and suggest helpful exercises whenever she needs them. And Sarah Jackson, who has bipolar disorder, says an app called True Colours helps her understand whether she’s getting too high or low, what might have triggered an episode and how she’s progressing.
In January, the government announced that it would give £67 million to six NHS trusts to develop and share new digital technologies to help tackle mental health issues. And in 2015 the then science minister George Freeman launched a £650,000 prize fund to encourage companies to create mental health apps. Since then, more and more such apps have been popping up – aimed at helping adults and children, and at communications networks between mental health providers and the police. On top of that, the government has now allocated another £3 million for the development of cognitive behavioural therapy (CBT) apps.
Ieso is one of the latest apps – it allows patients to talk to a therapist over instant messenger. Then there is Big White Wall, which facilitates therapy over webcam, and Thrive, which uses augmented reality and gaming software to help people manage their own mental health. Meanwhile, ClinTouch app, developed by the University of Manchester and Manchester Mental Health and Social Care Trust, enables users with psychosis to record their symptoms daily on a smartphone. And Cambridge Cognition has devised a way of using sensors in an Apple watch to monitor heart rate and skin temperature as a way of indicating stress.
Among cognitive behavioural apps, Silver Cloud stands out. It’s a guided CBT programme that asks patients to complete computerised modules, with progress monitored by a therapist, who speaks to the patient over the phone. And Feel Stress Free uses CBT to detect, prevent and treat depression and anxiety – with users tracking and training their mood, and learning relaxation techniques.
“Technology like this reminds people that help is out there, and shows them where to go to get it,” says Brian Dudley. A while back, when he was working at Broadway Lodge, a treatment centre for recovering addicts in Somerset, he helped to design an app for young people who self-harm. “Many young people who won’t go to therapy will access support privately, with technology,” he adds.
And it’s not just the UK that is turning to apps for help. The Black Dog Institute, a mental health organisation in Australia, has devised an app for indigenous Australians. Among young aboriginal people the suicide rate is five times the national Australian average. Research has found that they rarely seek help for mental illness, largely because of geographical isolation, stigma and concerns about confidentiality.
21st century solution?
The app uses the Warlpiri language, ceremony, skin name and law to foster a sense of identity and belonging. The idea is to help people reconnect with their culture, community and country, to build resilience and self-esteem.
In April, Singapore launched its first national video consultation app, and last year German company Soma received £1.8 million from the EU to develop an app that helps people to identify signs of stress at work. The app uses smartphone sensors to identify behavioural changes that tell an individual that they’re burning out and provides tips on how people can sleep better and relax.
German psychiatrist Andreas Meyer-Lindenberg is using smartphones to monitor how environment influences mental disorders in a group of volunteer migrants. The volunteers use their phones each day to answer questions about their emotional or psychological state in different surroundings. Researchers will then compare responses with data gathered from brain scans from the same volunteers.
This all sounds like a logical 21st century solution to a growing problem. People can access therapy online, at a time and place that suits them. And nobody else needs to know about it.
Not everyone, however, is convinced that this is such a good idea.
Martin Peters, clinical director at Lanna Rehab Centre, a luxury rehabilitation establishment in Chiang Mai, Thailand, thinks that apps can be helpful, but warns that the most important part of a person’s treatment – the human connection – shouldn’t be digitised. “Connecting with others is what a lot of people with mental health issues struggle with,” says Peters.
Doctor visits
Steve Flatt, director of the Psychological Therapies Unit in Liverpool, agrees that digital services shouldn’t replace traditional face-to-face therapy. “A therapist can pick up physical and behavioural cues from the client if they’re in a room together,” he says, adding that only a professional can help a patient solve problems by setting their imagination to work on the issues at hand. “Artificial intelligence is not advanced enough to deal with all possible answers to a particular question,” he says.
Then there is the other side of technology: excessive use. Studies show that some people may actually develop mental health issues if they use gadgets and social media too much. For instance, separate reports from Lancaster University and the University of Maryland last year found that people who compared themselves to others online were more likely to feel depressed. As were those who ruminated on what they see online.
And a 2015 Office for National Statistics report said that social media can delay children’s emotional and social development, making it difficult for them to distinguish between reality and virtual world fantasy.
Iris Elliott thinks that more research is needed to distinguish between social media’s harmful and helpful effects, but adds that this shouldn’t stop it being used to help people with their mental health problems. On the other hand, Steve Flatt says that using social media for therapy might isolate further people who already have reclusive tendencies. He’s more concerned, though, that the UK government’s new digital mental health directives are being driven more by a desire to cut costs, and less by how best to treat individuals. And, he adds, there should be a very clear way to see whether the strategy is actually working.
“The crucial measure of success should be how many people return to what they were doing before their distress began – and that isn’t being measured,” says Flatt. “There’s no point in completing an online course if you don’t feel any better at the end of it. It’s like going back into a chemical plant after a gas leak with a gas mask on rather than mending the leak.”
There is an economic argument for all this. Encouraging people to use digital mental health services would free up NHS clinicians’ time and keep the so-called ‘worried well’ out of their GP’s surgery. That’s a phrase coined a few years ago to describe the growing number of allegedly healthy people who self-diagnose with the help of internet search engines.
Sounds logical enough, from an economic viewpoint. A digitised system would eventually be a whole lot cheaper to run than the current arrangement. But it’s also easy to imagine the newspaper headlines if anyone suffering from a mental issue was to die because they’d been encouraged to use an app rather than see their doctor.