There’s an App for That? Merging Technology and Mental Health

Exploring technology and mental health in modern care
Every Job is a STEAM Job is our series looking at why kids will need tech literacy and coding skills to succeed in their future careers, no matter where those careers take them. Previously, we looked at how technology is changing film, construction, archaeologists, set designers, teachers, fashion designers, architects, journalists, small business owners, and the professionals protecting our national parks. If you scrape your knee or bruise your arm, the treatment is easy. The symptoms are visible and you can watch the scab heal and the bruise fade. Unfortunately, not all wounds are that easy to see. The field of psychiatry works to treat mental illness and help people who struggle with their thoughts and emotions. The symptoms are hard to see and the causes are even harder to treat. Doctors and scientists are working to make these symptoms more visible and treat them better. One tool that many professionals use is technology, which is opening up a new world of psychiatric treatment to patients and doctors alike.

Technology Can Improve the Field Of Psychiatry

Doctors and medical experts have made monumental leaps in the field of psychiatry over the past few decades and public awareness about mental illness is higher than ever. However, there is still a long way to go. In an article for TechCrunch, Adam Seabrook highlights the prevalence of mental illness in the United States. Almost 19 percent of Americans suffer from some form of mental disorder. That’s nearly as many people who have heart disease (11.5 percent) and cancer (8.5 percent), the two leading causes of death nationwide. “Imagine the public uproar if 50 percent of heart disease and cancer patients couldn’t find treatment,” Seabrook writes. “That’s what mental health patients face. More than half go untreated or undiagnosed, leading to...more than 37,000 suicides every year.” Considering that 90 percent of psychiatric patients who receive treatment experience improvement, ensuring care is available could have a significant effect on millions of people, our country, and the economy.

American Communities Lack Mental Health Resources

Not only is there a lack of affordable psychiatric care for most Americans, there’s a lack of resources of any kind in many rural communities. This has led many doctors and public health legislatures to encourage the adoption of digital solutions. “In 2016, a surprisingly low percentage of us are using [technology] to deliver care, despite the fact that half of the counties in the United States lack psychiatrists – and telemedicine has been shown to improve access to care,” Dr. Steve Daviss writes for MDEdge. “Nonetheless, telemedicine and other uses of technology across all specialties is growing quickly, as usability, mobile technology, economics, and policy-making all converge.” And it’s not just those in healthcare services who can help. Some believe the American healthcare system and state of mental health treatment is so broken that outsiders can see the problems and work to fix them. “Inefficiencies in healthcare make it ripe for disruption,” psychiatrist Dora Calott Wang writes at Huffington Post. “Amazon is entering the pharmacy business, and Facebook is working on mood and sentiment analysis. Doctors can wear Google glass, so that scribes can observe and do write-ups, allowing doctors to focus on patients.” This has led doctors to use existing technology to improve mental health care while assisting in the development of new tools that can be used in the future.

Telepsychiatry Provides Affordable and Global Alternatives

Modern technology brings better health services to communities that have never been able to talk to psychiatrists before. One company, Inpathy, provides services whereby patients, from their own homes, videoconference with mental healthcare providers. Patients might choose to use the online platform because there are no psychiatry services near them, because they’re homebound and can’t travel to their appointments, or because they need to talk to someone late at night — outside of traditional counseling hours. Telepsychiatry provides opportunities for people who need assistance but can’t follow a traditional counseling path. Missouri is just one state that has had success implementing telemedicine. Michele Munz at the St. Louis Post-Dispatch reports that the state’s main healthcare facility conducted more than 36,000 telepsychiatry sessions in 2016, more than triple the 11,000 sessions conducted five years ago. The state of Missouri has also used its telepsychiatry resources to treat young people who might act out without a healthy outlet for their emotions. “The state juvenile justice system has over the past three years equipped many of its residential facilities to receive telehealth care from psychiatrists at the University of Missouri School of Medicine, which is studying the impact in cost savings and health outcomes,” Munz writes.

Telemedicine Paints a Clearer Picture

Telemedicine isn’t just about convenience, it’s also about understanding the patients and getting a glimpse into their worlds. Dr. Zereana Jess-Huff told mHealth Intelligence that one psychiatrist met with a patient for six sessions to discuss clutter in her home. The problem seemed mild until the psychiatrist saw for herself that the patient was a hoarder. “You can actually get into their environment” Jess-Huff says. “More than any other use case, this makes psychology an ideal [platform for] telehealth.”

Psychiatry Without Borders

Telepsychiatry can cross borders and help communities outside of the US, bringing training and mental health to the most remote corners of our planet. NPR interviewed Dr. Hussam Jefee-Bahloul, who created the Syrian Telemental Health Network. This online platform connects Syrian mental health workers with training materials and resources from around the world. “For every mental health provider in our network, there is a specialist who is holding their hands kind of, you know, through difficult cases and kind of [helping them, training] them,” Jefee-Bahloul says. Right now there are fewer than 75 psychiatrists in the entire country of Syria, so these digital lifelines provide emotional support for the medical professionals as well as job-training and resources.

Modern Technology is Changing Depression Treatment

More doctors are turning to technology instead of medication to treat patients. Technology can be used to treat the root cause of some problems instead of just the symptoms. Dr. Keith Ablow uses dTMS, or deep Transcranial Magnetic Stimulation, which stimulates under-active parts of the brain. The patient is awake during the procedure and wears a padded helmet that uses a similar magnetic process as an MRI. By stimulating nerve cells that aren’t functioning like they should, this technology works to treat depression, anxiety, and other mental health problems. Ablow isn’t the only doctor looking at brain stimulation to treat mental illness. About one-third of patients with post traumatic stress disorder don’t respond to standard interventions, which has lead some doctors to test repetitive transcranial magnetic stimulation to reduce or enhance the stimuli of someone who suffers from PTSD. By stimulating the brain in a similar manner as the dTMS used by Dr. Ablow, patients saw decreased levels of re-experiencing, avoidance, and hyperarousal. They also reported lower levels of anxiety, Linda Peckel reports at Psychiatry Advisor.

Depression Treatment in the Palm of Your Hand

If the idea of space-age psychiatry helmets makes you nervous, there are other options to treat depression. Patricia Areán at the University of Washington Health Sciences and UW Medicine developed a video game interface called Project: EVO that is designed to promote focus and attention through “problem-solving therapy.” Currently, the technology is undergoing clinical trials to treat Alzheimer's disease, traumatic brain injury, and pediatric ADHD. In an article for Psychiatric Times, doctors John Torous and John Fromson report that more patients are bringing up the concept of app technology to monitor and treat psychiatric issues than ever. “It is estimated that there are currently more than 400,000 healthcare–related apps with thousands specific to psychiatry,” they write. “Professional organizations (eg, the American Psychological Association) have issued practice updates to reflect the growing importance of this technology.” Apps and games like Project: EVO make it easier for doctors to assign homework to patients and monitor whether they complete it. The games are also supposed to make the work more engaging — increasing the likelihood of patients using them.

Using Artificial Intelligence to Create Virtual Psychiatrists

Along with gamification, mobile tools are also used to help patients talk through their problems. Woebot is an artificial intelligence chat bot that uses cognitive-behavioral therapy, or CBT, to connect with patients online. The technology is available at no cost 24/7, making it a much more accessible service than traditional in-person appointments. “A review of studies published recently in the journal World Psychiatry compared people who received CBT online with people who received it in person and found that the online setting was just as effective,” Erin Brodwin writes at Business Insider. Because robot technology is new to the field of psychiatry, there aren’t a lot of comparisons between the two. The team at Woebot is working to conduct studies to see how chatting with a human differs from a robot psychiatrist.

Technology Helps Treat and Overcome PTSD

Private psychiatrists aren’t the only ones interested in digital tools and telepsychiatry to reduce the effects of PTSD. For the past few years, Veterans Affairs has been developing web-based and smartphone tools patients can use to work through fear, anxiety, and anger. “VA's Dissemination and Training Division creates material that could help reduce veterans' traumatic stress, especially if it's smartphone or web-based,” Mohana Ravindranath writes at Nextgov. “Still, the VA website describing existing apps emphasizes they shouldn't replace face-to-face professional care. The apps, however, can help rural and disabled veterans and staff access health resources where they are.” While PTSD affects people from all walks of life, it’s closely associated with military personnel. Vietnam veterans still report PTSD side effects decades after serving while enlisted soldiers suffer from flashbacks or triggers days after they step away from the field of battle.

Virtual Reality and PTSD

In many ways, technology is used to advance existing treatments and make them more effective. This is how doctors came to combine existing exposure therapy with virtual reality simulations. As patients talk about their experiences, they relive them through VR and learn to face the trauma. “Exposure therapy is an ideal match with VR,” Albert “Skip” Rizzo, a research professor at the USC Davis School of Gerontology, writes. “You can place people in provocative environments and systematically control the stimulus presentation. In some sense it’s the perfect application because we can take evidence-based treatments and use it as a tool to amplify the effect of the treatment.” Doctors will ask patients to describe their traumatic scenarios in great detail and create them through virtual reality. It’s a slow and excruciating process, but it helps PTSD sufferers unpack their trauma and process it in a healthy manner. While in the past VR therapy has been too expensive for general accessibility, Alex Senson at TechCrunch writes that as virtual reality enters the consumer market, that cost is decreasing and market devices are starting to be used by psychiatrists and patients alike. Patients can benefit from accessing VR exposure therapy without having to travel to a clinic. In-office psychiatrists could have VR headsets in their offices and use software programs to treat patients. VR could even create an office setting for patients to really feel like they’re meeting with a psychiatrist -- whether they’re actually talking to a health professional or just an AI chatbot. Technology isn’t the perfect solution to cure depression or end PTSD, but it can be used as a tool to treat patients and help doctors better understand the people they want to help.

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