What’s with all this technology in mental health care?

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Let’s talk about the use of technology in mental health care. We can think of this in two main areas of general and mental health care delivery; virtual appointments and mental health Apps.

The delivery of health care services overall during the past three years of the coronavirus pandemic has presented an enormous challenge for providers and patients, necessitating adaptations to the delivery of care model. This has been key for persons who have mental illness – research data shows that the numbers of those in the US who have experienced depression and anxiety has risen from approximately 16 million per year in 2016 to 21 million persons per year in 2020. One thing we’ve learned during this global crisis is that many, but not all, of us can successfully receive health care services using electronic information and communication technologies that support remote, or virtual, clinical health care. This of course depends on the nature of the visit and the need for physical examination and being physically present.

Technology use has become an indispensable clinical tool that has served to advanced the level of health care services. Here’s a few terms to define. Telehealth refers to the use of technology for any remote (virtual) clinical encounter or any remote non-clinical services such as patient education and monitoring, provider training, and administrative uses.  Telemedicine refers specifically to remote clinical services, meaning virtual appointments in general medicine or mental health.  The use of technology and the ability to have virtual appointments can increase a person’s access to general health care and mental health care services, especially if you live in a far-away or remote geographic area. One advantage of technology use in health care is that it’s more flexible with respect to our time and requires no travel and less time off from school or work.

The US Government Accountability Office (GAO) has reported dramatic increases in the use of telehealth services in the general Medicare and Medicaid populations during the pandemic as compared with pre-pandemic (5 million telehealth services increasing to over 53 million services one year later; and 2.1 million telehealth services rising to 32.5 million one year later). Similar increases in technology use in mental health care delivery were reported in a cross-sectional, national online study of 2,619 licensed psychologists practicing in the United States, where researchers reported 7.07% of clinical encounters were virtual pre-pandemic, rising to 85.53% during the pandemic. Two-thirds of the psychologists surveyed reported conducting all of their clinical work using telemedicine. This trend in the use of technology is expected to continue.

Unfortunately, although technology can promote access to clinical care, some of us who experience mental illness have limited access to or barriers to the use telehealth services and virtual appointments.  For example, a person may lack a stable residence, have limited access to smartphones, computers, or broadband internet connectivity, or lack the confidence or required technical training and skills to use these resources. These challenges are more pronounced in those of us who have serious mental illness or are psychotic.  Substantial obstacles also exist for older adults, such as lack of technological literacy, hearing loss, and lack of comfort or desire to see providers virtually. Language barriers in those who are non-english speaking presents another barrier to telehealth access. One proposed solution has been to engage health care extenders, such as mental health aides or peer supporters, who can reach out to vulnerable persons and problem solve.  Research is ongoing in this area.

There has also been an enormous effort to develop technology Apps for use in mental health support, education, tracking of symptoms and the illness, and as an augmentation to clinical care.  Some, but not all of these, have been useful and popular, particularly among the younger generations. The advantage is that one can use these Apps anonymously, without friends or co-workers finding out, thus diminishing the stigma of mental illness. They are also flexible with respect to time and requires no travel and less time off from school or work. The downside is that one misses the interpersonal interaction with and valuable guidance and support from a professional mental health care provider – part of the therapeutic recipe for success. The burden is also on the user to evaluate and choose those programs which provide reliable information and direction, and this is very difficult to do.

One highly recommended way to evaluate the many Apps out there is to use the online tool PsyberGuide.com, a non-profit website dedicated to help consumers make responsible and informed decisions about electronic therapies and tools for mental health.  This is a free program for you to search and narrow your selection of virtual Apps to suit your needs, say if you’re looking for help with anxiety, depression, etc..  PsyberGuide reviews mental health Apps based on their credibility, user experience and transparency of privacy practices. They look at the research supporting the technology and the development process, and review privacy policy policies about what happens with the information you enter into the App.

Mental health Apps and online education materials are limited to those persons who are without the barriers to technology use that I mentioned earlier.  Unfortunately, these barriers create a technology gap that disproportionately places some vulnerable persons who have mental illness at increased risk for inequities in health care.  This must be addressed by researchers and technology developers, with input and pressure from users and our communities.

Stay Well!

A version of this blog was previously posted on Psychology Today in View from the Mist.