June 25, 2019
How technology is transforming mental health treatment
Digital technologies should have much to contribute to tackling mental health conditions. Treatment can take place remotely and some patients may prefer to discuss problems through a screen rather than face-to-face. Plus, in the UK, and globally, there is a big gap between demand and capacity for treatment, something that technology could help fill.
The greatest potential is in "blended treatments", where self-service and automated technology supports healthcare professionals, says Dr Jen Martin, senior programme manager at the mental health MindTech MedTech Co-operative - a national centre focusing on the development, adoption and evaluation of new technologies for mental healthcare and dementia. "Where digital has a real role to play is in that additional help, while someone is having traditional face-to-face therapy," she says. Much research and funding has gone into digital mental health therapies. "The big blocker is NHS adoption. It needs to be embedded into systems."
Embedding is already happening, however - Greater Manchester mental health foundation trust uses ClinTouch, for example: a mobile app for people recovering from psychosis, schizophrenia and bipolar disorder. Although patients will typically see a care co-ordinator monthly, symptoms of a relapse can appear within days; with the app, users are asked how they feel a few times a day, and an alert is generated if a relapse looks likely. Shôn Lewis, University of Manchester professor of adult psychiatry, says about half of patients find it useful and most stick with it; some even suggest new functions, such as a diary facility and medication reminders.
But it has taken time to convince healthcare professionals. "They thought it was science fiction, it would never work, patients would never use it," says Lewis who started working on ClinTouch a decade ago. But other trusts are piloting the app, which is also set to be made publicly available later this year.
Affigo, the not-for-profit organisation that manages the app, is also looking at how wearable devices and social media usage could contribute useful data. And University of Manchester clinical psychologist Dr Sandra Bucci is adapting the app to provide a cognitive behavioural therapy service for psychosis patients, with plans to test it in a clinical trial.
Some NHS organisations have adopted telepsychiatry - videoconferencing therapy sessions. Healthcare technology company Healios provides nearly 30 clinical commissioning groups and mental health trusts with such services, including the option of involving several members of a family in a single session. Founder and chief executive Rich Andrews sees potential for much greater use of data analysis, comparing this to how physical conditions are diagnosed through biomarkers such as high levels of cholesterol in blood: "One area I think is incredibly exciting is how we develop the digital equivalent of cholesterol for psychiatry," he says. Mental health often relies on paper questionnaires and people's memories, but digital technology could instead analyse people's voices, monitor how fast they swipe mobile devices, and analyse the contents of social media images and the language of written messages, says Andrews.
Virtual reality (VR) is another technology that can be used for mental health. Daniel Freeman, University of Oxford professor of clinical psychology, has led the treatment of fear of heights by placing people in a virtual atrium through the use of headsets. A scientific trial found that the results exceeded those of face-to-face therapy, and it is now available on the NHS in some places in England.
Freeman and colleagues are now working on gameChange, a six-session programme that tackles psychosis by placing people in virtual equivalents of a bus or a cafe. Users work through levels of difficulty, such as the bus getting more crowded or needing to ring the bell and becoming the centre of attention. "We find people overestimate what bad things will happen," says Freeman. "They find in VR that they can look at people, they can order a coffee in a cafe and everything is fine."
Freeman thinks VR will help people with a wide range of mental health conditions, including obsessive-compulsive disorder and depression. "There's no shortage of ideas. It's just we have to commit the resources, disorder by disorder. We have years of work for our programming team," he says. "There are no technical barriers here."
'The children and introducing older people to tech and older people are sharing their life experience - it's mutually beneficial'
A care home in Wales is introducing its residents to tech - and helping them connect with younger people
Tom Jones is better than medicine for residents of Woffington House, a dementia care home in Gwent, Wales. "When someone is becoming upset or anxious, we go on to YouTube and show them Tom Jones, particularly his 1966 hit The Green, Green Grass of Home," says registered home manager Adam Hesselden.
Since the home introduced residents to Apple iPads, Amazon Echo Dots and virtual reality headsets two years ago, it has found that the need for anti-psychotic drugs has all but disappeared, and emergency ambulance calls have fallen by 29%.
The technology has enabled residents to undertake virtual travel through the headset or projectors. This can be down the road, to judge the Easter bonnet parade at Georgetown primary school in Tredegar, but also to other places the residents know.
The home is now considering offering virtual cruises and train journeys as well.
For Hesselden, the initiative is a way to connect Woffington House's residents to the world outside: "These people need meaningful occupation, a purpose and something to do, as opposed to being sat inappropriately sedated in a care home."
The home's original reason for investing in the technology, though, was to help regularly-visiting schoolchildren to bond with residents as part on an inter-generational project, which has gone from strength to strength.
"The children are introducing the older people to technology, and older people are sharing their life experiences. They are mutually benefiting from the experience," says Hesselden.
Children have also been able to learn from residents' histories through emailed questions, on topics including the second world war and what it is like to be a steam train engineer.
"We've got a whole bank of experience cooped up in a care home that maybe isn't being utilised enough, and it's free," says Hesselden.
Technology - and, perhaps more importantly, enthusiastic schoolchildren - are providing an outlet for just that.
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