Digital technology & youth mental health – Part 4: What might the future look like? – August

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Now we have understood how technology can be a force for goodstepped care and mental health, and the role that digital technology can play in this, it’s not difficult to see how further technological advancements can develop to provide real opportunities to develop the quality and accessibility to care in the future.

What might the future look like?

Every day, more and more innovative solutions are emerging in the e-mental health arena – including video conferencing solutions, virtual and augmented reality, chatbots, smartphones, apps and even wearable devices with sensors (devices that measure physiological and behavioural data, such as heart rate and sleep patterns). While this may all seem a little ‘space age’ for some – it’s worth remembering how quickly new technologies have been adopted in many areas of our lives – from internet dating in our personal lives to mobile phone payment in banking. Let’s look at some of the recent and upcoming innovations in the mental health space.

Telehealth and telemedicine.

Telehealth is defined as ‘the use of telecommunication techniques to provide medical education and health education over distance’. It’s distinct from telemedicine, which is ‘the use of advanced telecommunication technologies to exchange health information and provide health care services across geographic, time, and social barriers.’

Put simply, telemedicine refers specifically to remotely delivered clinical services, while telehealth can refer to remote non-clinical services.

How might it help?

Since the COVID-19 pandemic, telemedicine use has accelerated dramatically in most health services across the world. However, there were a number of settings that were ahead of the curve in this space. One example of effective telemedicine in Australia is eheadspace. A confidential, secure digital space, it allows young people and/or their families to access web chat, email, or speak on the phone with a qualified youth mental health professional.

If a young person is feeling unwell or experiencing difficulty with their mental health—anywhere around the country—eheadspace provides a platform for clinical support. It gives clinicians a place to provide education, insights, and support. Then it makes this easily accessible to the young people it is designed to help, giving them the skills and knowledge to build coping skills.

eheadspace is unique to many online mental health supports, because it meets the definition of telemedicine: it’s staffed by qualified clinicians as opposed to counsellors, the conversations are clinically documented, and the support approach is peer-reviewed and informed by evidence-based research.

Sensors, wearables, and nanotechnology.

Wearable technologies are any devices that can be worn as accessories, embedded into clothing, implanted in a person’s body, or even tattooed on a person’s skin. The devices are usually hands-free microprocessors with the ability to send and receive data via the internet.

How might they help?

Many wearable sensors have been developed to assess a person’s stress levels and mental state based on a number of inputs like heart rate variability (HRV), galvanic skin response (a change in the resistance of skin that is commonly measured in lie-detector tests), and other biomarkers measured in sweat.

By tracking this type of data, it can be cross-referenced with other information such as geotracking. This allows young people to build insights into when or where (and ultimately unpacking why), they are likely to experience certain symptoms associated with conditions like anxiety or depression.

Digital pills.

In 2017, Otsuka Pharmaceutical won the approval for a new product, Abilify MyCite. It’s a pill that—once swallowed—activates an ingestible sensor that sends a message to a patch worn by the patient. This then transmits information to a mobile app for the patient, their family, or a clinician to monitor information and updates.

How might they help?

Memory loss, confusion, and cloudy thinking are common symptoms associated with depression. This can make it difficult to stick to the frequency and dosage of medication requirements of prescription treatments. Although an additional reminder may not be proven to help people take medication, the information could be invaluable to family members or friends and may provide visibility that could ultimately save lives.

Chatbots.

Chatbots are a type of conversational user-interface. They’re a form of artificial intelligence and they respond flexibly to a user’s questions or prompts in chat-message style, which creates the experience of talking to a person.

How might they help?

Chatbots are a support option in the earlier stages of a stepped care model. They are particularly useful when young people live in rural communities or if they are employed in a role with shift work. Offering 24/7 consultation, they give the user a degree of anonymity – which can overcome stigma and break down barriers with potential patients. Offering instant access to relevant self-help information, chat bot interactions can be configured to be more natural and supportive than other interfaces.

We shouldn’t forget, however, the ethical considerations around the use of chatbots in a mental health setting. Specifically, the responsibility placed on a chatbot to accurately identify and guide a young person in a state of distress. Due to their very nature, there can be an inability for a chatbot to mimic empathy or understanding. Both of which can be required in a sensitive clinical interaction.

Digital phenotyping.

In genetics, a ‘phenotype’ is the observable traits of an organism: appearance, development, and behaviours. ‘Digital phenotyping’ is the process of automatically and continuously collecting data from smart devices to build detailed, personalised insights into a young person’s online behaviour. This can include smartphone-measured sleep continuity or monitoring typing fluency.

How does this relate to youth mental health? Psychologist Dr Peter Baldwin from The Black Dog Institute explains:

“Several of my colleagues are helping create so-called ‘living laboratories’, harnessing key insights from large groups of people’s mobile device use to help us understand and even shape the behaviours that keep people happy and healthy. Other researchers at Black Dog are working to understand how an individual’s social media posts can be used to provide them with tailored mental health recommendations based on machine learning models of mental health risk.”

How might it help?

With this information, clinicians can track markers of depression and anxiety, develop new ways to diagnose illnesses, choose effective treatments quickly – and detect relapse before it occurs.

Virtual reality.

Virtual Reality (VR), a simulated experience which usually involves wearing a VR headset, is certainly nothing new. For decades, VR technology has been used primarily for entertainment and education. But a new wave of psychological research is pioneering VR to diagnose and treat medical conditions from social anxiety to chronic pain to Alzheimer’s disease.

How might it help?

As explained in this Scientific American article:

“Today’s VR content is primarily designed to aid exposure therapy, a treatment for anxiety disorders in which patients are exposed to anxiety-inducing stimuli in a safe, controlled environment, eventually learning that the “threats” they’re worried about are not actually very dangerous.”

Exposure therapy traditionally occurs in real-world situations. But VR technology is now being used to simulate those experiences in a safe, controlled environment. It’s safer, quicker, and less expensive.

The potential of digital use in youth mental health provision is developing daily.

The current use of digital technologies is just the start. As treatments progress and understanding of digital advances, it only requires a short leap to understand how they can not only be used together to build a better, more accessible service. As understanding grows, these digital technologies will aid clinicians, allowing them to treat more patients effectively – reducing waiting times and rejection rates. New and emerging technologies will be quickly adopted to allow earlier access to treatment, and allow all patients to be helped at the correct level.

We’re already close to digital technologies helping to advance more complex treatments and provide safe and structured methods of delivery to young mental health patients – offering digital technology solutions for all stages of stepped care in mental health.

In the future, we can imagine a world where clinical approaches will not just use digital technology, they will co-exist in the development stage. Data will feed into solutions and strategies. AI will accelerate clinical learning. Digital brains helping to fix human ones.

The truth is, we can’t predict what we might achieve when current intelligence is magnified by the tools AI may provide. But digital technologies will undoubtedly provide new opportunities in mental health that are unimaginable today.

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