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Technology's impact on mental health a tale of telepsychiatry and apps
The Day - 9/21/2023
Sep. 20--Of all the health care specialties, psychiatry was perhaps best-suited for telehealth the remote linking of health providers and their patients which exploded during the COVID-19 pandemic and in its aftermath.
What could make more sense than socially isolated patients connecting with their mental health providers via the internet, on their computers and mobile devices? After all, mental health treatment typically requires no physical contact. And telepsychiatrists can still derive some information from an on-screen patient's facial expressions.
"What we have seen in practice is that those patients who had to do telepsychiatry during COVID, have stayed with it," said Dr. Manu Sharma, assistant medical director of research and innovation at Institute of Living, a Hartford psychiatric facility affiliated with Hartford HealthCare.
From the patient's perspective, Sharma said, telepsychiatry's advantage over in-person appointments is largely convenience. Patients don't have to navigate such things as geographical obstacles, parking and the need to schedule child care. Appointment no-show rates have plummeted, he said.
But telehealth has its disadvantages.
"You can pick up on body language (during an in-person visit)," Sharma said. "For example, in the case of tremors (which can be caused by drugs prescribed for bipolar disorder and other psychiatric conditions), it's hard to see them during a telehealth appointment. We can't detect rigidity. ... Sometimes, a patient (on a call from home, say) is too distracted, the kids may be running around, or privacy can be an issue the patient doesn't want to talk in front (or within earshot) of others."
"We do give them a choice," Albert said of Institute of Living patients. "Some come in, some do telehealth. It's about 50-50."
The use of apps is growing
The telecommunications industry has also impacted mental health through advances in software and digital devices that have revolutionized the collection and sharing of data. Web-based applications, or apps, designed to monitor patient symptoms, promote well-being and store patient records have proliferated at a rapid pace. Sharma said he recommends wellness apps that can remind a patient to take medications, for example, or record moods, but cautions that apps are not a substitute for face-to-face psychotherapy.
In an article he co-authored earlier this year, Sharma identified Calm and Headspace as among the best-known mental health apps that benefited from an exponential increase in downloads during the pandemic.
Headspace provides "mindfulness tools for everyday life," according to its website, "including meditations, sleepcasts, mindful movement and focus exercises. Our enterprise offerings combine this experience with a human-centered model of care, with coaching, therapy, psychiatry and EAP (employee assistance program) services under one roof."
The app offers access to a team of experts ranging from mental health clinicians to "Emmy award-winning producers and data scientists" who have helped more than 70 million people in 190 countries, the website says.
"Although very preliminary evidence suggests that these apps have been helpful in the reduction of perceived stress in nonclinical populations, there is next to no evidence to support the use of these applications in a clinical population," Sharma wrote. "There are a limited number of randomized clinical trials that explore the efficacy of smartphone-based cognitive behavioral therapy. Yet, there are several apps on the market that claim to provide evidence-based CBT (cognitive behavioral therapy) for insomnia, depression, post-traumatic stress disorder, and anxiety."
"Unfortunately," he continued, "initial evidence with regard to their efficacy has been underwhelming."
In the article, Sharma noted that emerging companies are offering apps that enable a patient to text a virtual therapist at any time. Apps such as WoeBot use natural language processing to decipher text sent by a patient and respond immediately using preprogrammed answers based on CBT or supportive therapy principles. Other apps, such as BetterHelp, use synchronous replies from therapists to facilitate therapy.
"Initial evidence of the efficacy of such interventions is encouraging," Sharma wrote.
How to evaluate an app
The American Psychiatric Association has developed a process for evaluating mental health apps. Available online, the APA App Advisor employs a model based on information that patients and providers should consider when choosing an app. The most fundamental questions that should be asked include:
On which platforms/operating systems does the app work and does it also work on a desktop computer?
Has the app been updated in the last 180 days?
Does the app collect, use and/or transmit sensitive data? If yes, does it claim to do so securely?
Is there evidence of specific benefit from academic institutions, user feedback or research studies?
Does the app seem easy to use?
The increase in the use of mental health apps has raised concerns about the security of the personal information users provide. In February, a student researcher at Duke University reported the results of her study of data brokers companies that collect personal information and resell or share it with others and data on U.S. individuals' mental health conditions.
The student, Joanne Kim, found that data brokers and most companies that operate health apps are exempt from HIPAA, the law that restricts access to such information. Some of the brokers she studied "advertised highly sensitive mental health data on Americans, including data on those with depression, attention disorder, insomnia, anxiety, ADHD (attention deficit hyperactivity disorder) and bipolar disorder ...," the report says.
In March, the Federal Trade Commission and BetterHelp reached a settlement over allegations the mental health app shared consumers' health data with companies like Facebook and Snapchat for advertising purposes.
As part of the settlement, BetterHelp was banned from sharing consumers' health data and agreed to pay $7.8 million to consumers to settle charges it revealed sensitive data to third parties. BetterHelp admitted no wrongdoing, saying the settlement was related to its advertising practices in effect from 2017 to 2020.
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