The Future of Psychiatry Is Digital. That’s a Good Thing.

Just as technology has transformed other aspects of our lives, I believe it has the potential to provide more people with access to quality care.

  • Currently only half of people with depression access potentially adequate treatment, according to one study. Digital devices could help.

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Ella, who is in her early 20s, has depression. When her sleep started to fall away after a stressful term at school, her smartphone was programmed to note the late-night texts and phone conversations indicating her insomnia. It made suggestions to improve her sleep.

When her social media posts grew more negative and she was calling friends less often, her phone had her do a depression scale, booked her in to see her psychiatrist, then uploaded the scale results and a log of her recent sleep patterns.

She connected with her psychiatrist though videoconferencing and this doctor made some medication adjustments. Ella also began some focused psychotherapy through an app.

Ella isn’t real, but hundreds of thousands of Canadians do have major depressive disorder. Today, smartphones don’t pick up on insomnia, and they don’t set up appointments with psychiatrists. But one day they could.

We may soon use smartphones and wearables to help treat depression. As a psychiatrist, I see this as a good thing, allowing more people to access quality care.

Mental health care is an area in need of transformation. One in five Canadians will have mental health problems this year, yet many struggle to access care. According to one study, only half of people with depression get adequate care.

Evidence-based psychotherapy is particularly difficult for people to access; a recent Canadian study found just 13 percent of people with depression had any psychotherapy. Yet cognitive behavioral therapy — a type of therapy that focuses on how a person’s thoughts can affect his or her behavior and mood — is as effective as medications.

Just as technology has transformed other aspects of our lives, people are increasingly tapping it for health needs. There are, for instance, more than 315,000 mobile health apps.

Many of my patients use apps for information on their illnesses; some incorporate apps into their care, helping them remember when to take medications or track their mood over time. And more people are now looking online for therapy.

Studies show that if the therapy is done right (with a therapist guiding the process), people can do as well as with in-person care, but at a lower cost.

The advantages are more than economic. For the single mother with three kids or the older person who hesitates to attend a clinic in the dead of winter, online therapy isn’t better care, it’s the only care.

Not surprisingly, the idea has proven popular with the private sector and also with governments in Norway and Sweden.

And there is great potential to see technology assist with all aspects of care. The majority of North Americans have smartphones, which are carried around everywhere.

By looking at speech patterns and our movements, smartphones could pick up on subtle changes indicating the start or worsening of symptoms, while wearables may notice subtle physical changes — long before patients themselves even notice problems. These devices could be bringing objective, real-time data to care.

Needless to say, the research is active; for example, several of my colleagues at the Center for Addiction and Mental Health in Toronto are looking at depression and Fitbit data to detect patterns that could signal the onset of depression earlier.

We also need to be careful. There are hundreds of depression apps, but quantity doesn’t mean quality. In one study, when a basic quality control standard was applied (such as revealing the source of information), only 25 percent of the apps studied passed the test.

Digital mental health also needs to include digital privacy and confidentiality. Just as banking information shouldn’t be shared recklessly, medical information carried on a smartphone or a wearable device needs to be safe for the user.

And conflicts of interest must be clear. A smartphone app, for example, shouldn’t be a hidden advertisement for a private company.

People often ask me if I think technology will soon replace psychiatrists. That’s unlikely to happen. But one day, a patient like Ella may tap technology to get better care. And that’s good news — if we have the government policies and provider practices in place to ensure that the technology is used thoughtfully.

The Conversation

David Gratzer is a psychiatrist at the Center for Addiction and Mental Health and an assistant professor of psychiatry at the University of Toronto.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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5 comments / Join the Discussion

    This is a totally self-serving, industry serving article written for a fantasy group of graduates of Medical Schools that teach sciences related to empirical things like setting broken femurs and removing ruptured appendix. MD’s are great for acute injury and failure, but struggle with chronic disease and geriatrics. However, psychiatry is in a class of its own. Psychiatry, few realize, treats its patients 100% with drug presecritpions; based on theory that all mental impairments are produced by an imbalance of internal chemicals for which there are no tests. Psychotherapy is dead to psychiatry. Nor are any diagnoses based on testing or any kind of replicable results. Psychiatrists have become purveyors of patent drug manufacturers, of which some like Pfeizer and Merck, have been caught falsifying data in clinical testing. So, smartphones as promoted by David Gratzer serve this idea that all their ‘patients’ need are further drug fixes that can be adjusted electronically and totally impersonally just as the case with office call clients of their industry. It is so very convenient for psychiatrist as well as the burgeoning drug industry. Adjust this dosage, add yet another synthetic fix for undesirable side-effects of the first or twentieth in drug arsenal. Effectiveness and safety, the big yardstick of FDA is used to measure imaginary chemical imbalances that are not and cannot be known. Nor are results objectively testable; no laboratory test to say “chemical balance”has been restored (or not). The only effectiveness of phychotropic medicines are known by their side-effects, the same haphazard trial-and-error kinds of effects that lead to their spurious ‘discovery’ by innovators in the laboratories. The drug industry trade journal, Tan Sheet, provides a weekly revelaton of FDA recalls of drugs they formerly and blindly approved, based only on the manufacturer’s claims. Most readers have family or friends who have traded clinical depression as diagnosed by industry flacks, for the experience of induced manic depression by such drugs as Ritalin and Zoloft. What reader here does not have a friend or relative who has experienced “going off meds” because of unbearable side effects; the symptoms of which addictive dependency is worse than the original symptoms of their melacholy? No, I don’t speak of bipolar conditions but of drug induced simulacra. I personally have no stake in mental health care or Big Pharma activism, but critics like Samuel Epstein, MD and Jon Rappoport make much more sense than the pseudo-practice of ersatz psychiatry. Shame on UnDark to be so gullible as to promote such tobacco science even if it is camoflaged by digital trendiness.

    Can we, for even a moment, concern ourselves with the environmental causes for clinical depression, anxiety, borderline personality, etc.? Socio-economic problems that seem to have no personal escape, such as plunging social mobility, Simkins style career disaffection, perpetual war and genocidal military; poor health do not have chemical solutions, only band-aids. The time is coming when a national cannabis legalization means non-criminal people can self-dose with rather begnign results. There are many other and diverse medicinal plants for emotional problems included in old U.S.Pharamcopaea so people can avoid becomeing ‘patients’ of the xenobiotic synthetic patent drugs pushed by Big Pharma.

    This article is self-serving and drug industry serving. Psychiatry has become 100% treatment by drugs dominated by the apparently unprovable theory that all emotional disturbances stem from individual patient’s chemical imbalances. Yet these theorized physiological chemicals are not identified nor, of course, do tests exist upon which to base diagnoses. Drug industry market their wares with spurious clinical modelling and testing. Psychiatry is a sham that has repudiated psychology or any kind of human counseling or himan interaction. Hence, this kind of fantasy reliance on computers because personal visits are not needed because therapy is entirely impersonal and this author is hawking presecriptions. No wonder we have all time high addictions and concommitant suicides. Opiates are not the only drugs that are addicting. Side effects for mood altering drugs can be easily researched by reader/consumers of this idiocy. Look to the Tan Sheet that is the trade journal for the Pharmacy industry and you will see an average of one recall per week for formerly FDA approved drugs based on manufacturer’s own cooked up interpretation of their sometimes faked data. Buyer Beware !! Computers then have ability to duplicate a spurious service industry that masquerades under medical science that sets broken bones and removes burst appendixes, but solves few degenearative diseases. Do the readers have friends who have become physically dependent on drugs like Ritalin and Zoloft who vacillate between suffering depression and unbearable side effects of the drugs? Shame on UnDark for publishing such drivel. Can a depressed domestic violence mate get advice how to leave abuser from an effective parent or friend? Or as this charlatan suggests; just be happy to have a smartphone to futher their dependency on drugs to avoid changing their real life choices? Psychiatry is not scientific in the least. Own up!

    Ideally, one would hope digital access could assist those in need. However, sites can be compromised, and realistically would those in need be willing to reach out? Most likely not.

    Having problems connecting with public conservator LPS for LA County. Trying to get assistance in getting forms, talking to a real person. Any ideas?

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