By Dr Francesca Properzi, PhD. Research Manager, Centre for Health Solutions
Earlier this year, a team of US scientists connected the brains of three people using an interface made of electroencephalography and magnetic stimulation technologies. The new network enabled the three people to communicate by thinking, exchange ideas and successfully play a collaborative game.1 This ground-breaking experiment is yet one example of many other recent scientific advances where digital technologies are transforming our understanding of the mind. While controversial and somewhat alarming, these developments also present a unique opportunity to protect and support mental health, at a time of unprecedented technological changes.
As highlighted in our report ‘At a tipping point: Workplace mental health and wellbeing,’ the WHO, defines mental health as a state of mental and psychological wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. Mental health is determined by a range of socioeconomic, biological and environmental factors and is an integral part of our overall health.2 Moreover, our mental health is continuously changing due to social and personal factors, and for those affected by specific neurological conditions such as schizophrenia, autism, dementia and others their needs are also constantly evolving.3
Currently one in four people in the UK are affected by mental health conditions every year, with the most vulnerable segments of the population paying the highest price.4 Statistics are alarming for children and teenagers. Anxiety and depression in young people have increased 70 per cent in the past 25 years in the UK, largely attributed to social media bullying.5 Suicide is currently the third leading cause of death in 15 to 19 year olds in the country.6 Importantly, the vast majority of mental illnesses start before of the age of 25 and are undiagnosed, limiting the possibility of timely interventions and cure.7 For many people accessing the help and support needed in a timely manner is increasingly difficult. This is due the long waiting times to access mental health services and to the stigma attached. About 54 percent of people in the UK wait longer than three months to start a treatment and overall 75 percent of people with mental illness do not receive treatment at all.8
Resilience and e-mental health
How can emerging technologies support mental health rather than pose more threats? This year, Mental Health Day in October focused on a crucial concept at the core of mental strength and well-being: resilience, or the ability to cope with changes and setbacks in life. While we are all exposed to the emotional strain that comes from loss and uncertainty, resilient people respond by acknowledging and accepting new situations. Rather than avoiding negative feelings, they work through them daily, ultimately finding a way to recover.
One key factor to building a resilient mind-set is the ability to communicate and seek support. It is here that digital technology has the highest potential to intervene and help in a way that reduces the fear of exposure and reduce social stigma. Many people with a mental health condition can feel more confident talking about their concerns and difficulties using a digital interface such as a computer, smartphone or tablet, rather than face to face.9 Digital applications also have a lower cost, allow for more flexible timings and do not require travelling compared to face-to-face therapy. At the other end of the screen, there could be a professional care giver, a peer experiencing the same problem or an AI system using a tailored machine learning algorithm.
Evidence shows that what is more important than the source of support is its accessibility. A peer-reviewed randomised controlled study demonstrated that cognitive behavioural therapy can be appropriately delivered by AI trained chat-bots. This type of virtual therapy successfully reduced the symptoms of anxiety, depression, insomnia and other disorders in 70 subjects with high patient engagement.10 The company providing the service for free has also raised unprecedented venture capital funds to develop its AI functionality further. Other new virtual therapists can now analyse nonverbal clues in addition to verbal ones, such facial expressions, tone of voice, gestures and posture to deliver a more precise, personalized intervention.11
Virtual stimulation and activity-based therapies have also achieved significant and promising results in patients with dementia. One of the leading dementia apps integrates the active input of family, friends and care-givers to retrieve valuable memories and personal information of patients that are crucial for the success of tailored cognitive stimulation.12
A UK perspective
In the UK, one promising e-mental health developments is the Support Hope and Recovery Online Network (SHaRON) digital interface developed in 2009 by the NHS. SHaRON provides 24 hour peer to peer support, with clinical moderation and intervention. The system is designed to: support patients suffering from eating disorders, dementia and perinatal conditions; helps young people with mental health problems; and help relatives and carers of the elderly by providing a digital space where service users, clinicians and care givers can communicate safely. Support from peers experiencing similar conditions and community backgrounds has so far delivered very promising results, with more than 80 per cent of people using the service saying it has been helpful for the recovery.13
SHaRON was developed by Berkshire Healthcare NHS Foundation Trust, an NHS Global Digital Exemplar. Last year, the UK government committed to provide 60 million pounds to mental health digital exemplars and a total of 67.7 million pounds to develop digital mental health services within the NHS. Other mental health support initiatives include a pilot for digitally-assisted cognitive behavioural therapy, an application for improving communication with care givers during mental health crisis and new digital tools for children and young people dealing with mental health.14 The NHS also offers an application to help people suffering with insomnia as a form of digital therapy.15
The e-mental health library of applications
The number of e-mental health digital applications is increasing rapidly. Recent research identified 61 mental health apps now available online in the US, Canada, Australia and the UK, which explicitly refer to mental health diagnoses or symptoms and provide diagnosis and guidance. Fifty-six per cent of them are focused on anxiety, panic and stress, 26 per cent address mood disorders, and 18 per cent address well-being or other mental health issues. Importantly, the study questions the correct framing of mental health conditions, highlighting the risk of misleading diagnoses.16
In such a fast growing scenario, the key question is how is it possible to ascertain in a timely manner the efficacy and safety to patients? In the UK, the NHS has established a mental health app library, where apps are assessed for safety and security and are required to have some evidence of outcomes. The library currently holds a total of 20 mental health applications, including two apps focused on insomnia, a frequent symptom of mental illness.17
Many of the other apps are focused on prevention and mental well-being understanding, with relevant content dedicated to the management of emotions and addressed to everyone. Interestingly, in the early 2nd century AD, the poet Juvenal provided his fellow Romans with a list of what is most valuable in life for one of his Satire collections and notoriously wrote “You should pray for a healthy mind in a healthy body”. In 2018 the concept couldn’t be more relevant.
8 Department of Health. (2014). Annual Report of the Chief Medical Officer 2013, Public Mental Health Priorities: Investing in the Evidence. Retrieved from gov.uk/government/publications/chief-medical-officer-cmoannual-report-public-mental-health