The management of serious mental illnesses, including bipolar disorder, psychoses of various kinds and anxiety neuroses, usually involves many factors, including a long-standing relationship of trust and empathy between the patient and the therapist. A non-human interface, where much of the interaction is conducted via a computer screen or a mobile device, has limited applications under most circumstances. Other factors include the participation of caregivers, family, friends and associates of the afflicted person, largely because the assessment of progress or deterioration of the patient’s condition is often subjective, and difficult to quantify.
Yet technology-driven applications have a growing place in the overall ecosystem because of the sheer mismatch between trained mental professionals and the number of people that require urgent help. Incidentally, this shortage of psychological medicine specialists is not limited to India but have been observed in the US and other affluent countries as well.
Besides, efforts to improve the overall mental health of a country or even a single city can only be effective if they focus on early interventions, among school and college students, victims of domestic violence and child abuse, and various other vulnerable groups.
Social media sensitization
It is these early interventions that technology-based modalities, such as mobile apps, social media in all its varieties, tele-counseling and helpline services, have their greatest value. “In my view, the most common utilization of social media and other such activities is in sensitization and creating awareness in the general populace that mental disorders such as anxiety and depression can happen to anybody and they should not be hidden behind closed doors,” says Dr Samir Parikh, Director and HOD, Mental Health and Behavioural Sciences, Fortis Hospital, Shalimar Bagh, New Delhi. He went on to share his experiences at Fortis Hospital, which organizes a summer internship for young people to make them aware of mental health-related issues. In 2019, his team made social media their focus and with the help of Facebook, Instagram and so on, managed to reach over 20 lakh people in the space of just one month.
“I do a lot of webinars myself on various topics related to mental health and find it quite easy to reach 10,000 to 15,000 people on each occasion,” Dr Parikh said, adding that it was very cost-effective. Similarly, he said, geographical boundaries dissolved very quickly with the use of digital services, such as tele-counseling. Thus, a therapist sitting in Delhi could quite easily cater to a needy person from the hinterland of Bihar or Uttar Pradesh.
Dr Shamsah Sunavalla, a consultant psychiatrist with Jaslok Hospital and Research Centre in Mumbai, agrees that digital tools work very well when it comes to counseling and psychology education. However, “it becomes a bit tricky when medicines need to be prescribed across long distances, mainly because the Medical Council of India regulations are a bit unclear on this issue,” she says. However, long distance therapy can be attempted if there is a local psychiatrist at the other end, she points out.
A reticence to adopt digital tools is not limited to India or even to low- and middle-income countries such as those in Asia and Africa. Earlier this year, the first global survey on artificial intelligence (AI) and machine learning (ML) in mental health — involving 791 psychiatrists from 22 countries — was published. According to it, only 3.8 per cent felt AI would make their jobs obsolete, 17 per cent felt AI/ML would replace a human clinician for providing empathetic care, while 54 per cent felt AI would contribute the most in documenting medical records and synthesizing information – more among US physicians than in other countries.
However, the report also pointed out that the rapid spread of smartphones, wearable sensors and cloud computing has created huge opportunities for self-monitoring by patients and scaling access to healthcare, eliminating human error, providing more truthful patient responses, training of young psychiatrists, etc.
Meanwhile, on the international front, efforts are already underway to regulate more than 10,000 mobile apps that are available for download. According to a February 2019 editorial published in World Psychiatry, main concerns include data privacy, effectiveness and user adherence. The article also notes that a lot of patient end-users give up their app about two weeks after download, while clinicians’ adherence depends on familiarity with technology. As Dr Sunavalla says: “I don’t recommend mobile apps because I am not entirely comfortable with them.”
Other experts have also suggested that for mobile apps to be effective, they should be designed with help and feedback from patients as well as caregivers, including patients’ families.
Besides, in a study published last month in a PLOS (Public Library of Science) open-access journal, researchers from the All India Institute of Medical Sciences, New Delhi, reported that just about 30 percent of patients
and care-givers possessed smartphones, while 55-58 percent were using
feature phones that did not have internet access. In fact, a number of therapists encourage their patients to switch back to feature phones
due to the fear that unsupervised internet access might do more harm than good.
Some interesting observations did come forth. One was that IVRS (Interactive Voice Response Systems) often worked better than mobile apps, while visual modalities such as Skype and video-conferencing sessions proved more effective in therapy sessions. Besides, one study also recommended that smartphones could be used to make video-recordings of facial expressions of patients with serious mental illnesses.
Thus far, digital technologies have proved very useful in certain aspects of mental health and care, while in other areas such as formulating a plan of therapy, they have not been widely accepted as yet. What the future holds is difficult to fathom, because the development of technology may happen in directions that cannot be imagined at present. An example is VR (virtual reality) systems, which can expose a patient to any visual experience that a therapist desires.