Historically, the mental health industry has been slow in the adoption of technology; however, over the past few years, we have seen a growing need to boost technology’s role in mental health treatment, driven by growing barriers to entry such as shortage of appropriate staff, cost and location.
The number of people needing support far exceeds the availability of trained personnel currently available. In fact, Mental health First Aid England estimates 792 million worldwide experience mental health issues, and 1 in 4 set to experience a mental health problem of some kind each year in England. Furthermore, NHS waiting times are increasing, whilst protocols to access mental health treatment are narrowing.
In order to tackle these challenges, healthcare providers are forced to look at technology more than ever in order to offer efficient, affordable and accessible treatment – personalized to patients and their problems. The COVID pandemic has certainly brought about an acute awareness of tech’s benefits and forced doctors and patients alike to look into digital tools like smartphone apps to treat mental health issues. But what kind of treatment will drive us forward?
No such thing as a ‘one-size fits all’ treatment
Going back to basics, before advising on the suitability of any treatment, a doctor will consider, “What are we here to fix? How does this person see the world and their place in it?”. One of the biggest challenges is that there is no panacea for mental health issues, as it is a personalized experience for everyone. When one person loses their job, they might think it’s the end of the world, while another person could see this as an opportunity. Psychiatrists are like flying instructors; to begin with, we sit in the cockpit with patients to help them develop new skills to overcome difficulties, so that eventually they can fly off on their own. The aim is to enable people to take control of their lives, be more productive and happier overall.
When I see a patient for the first time, I ask them to tell me what they want to achieve in therapy. I tell them that we are locked in a room and I have a bunch of keys; at least one of them will open the door, but I don’t know which one yet. The brain is a complex organ – we can influence the way it functions in different ways: by introducing chemicals to change the way the brain reacts (such as anti-depressants) which incidentally promote the growth of new brain cells, or psychologically, by changing cognition. Each treatment has its place, and it’s our role as professionals to find the right one - antidepressants can help severe cases that cannot immediately benefit from psychological treatment.
Some GPs are becoming aware of the benefits that alternatives to prescription medication can offer. Mildly depressed patients, or patients suffering from anxiety, stress or PTSD can benefit from autonomous digital therapy to treat symptoms remotely - and most importantly – with privacy, safety and without side-effects. In order to develop the future of mental health treatment, we need to collectively reconsider the options available and be open to using evidence-based technology to cater to an ever-growing number of patients.
Changing treatment as we know it
Following the rise of cognitive behavioral therapy (CBT) and ‘self-help’ apps, doctors and patients are now looking at options that drive results and efficiently treat the underlying issues, as well as the symptoms.
In order to reach a wider audience efficiently, the range and types of treatment available will have to evolve. Biofeedback enables patients to be aware of their level of arousal to self-treat anxiety. eye movement desensitization and reprocessing (EMDR) therapy has been recommended by many psychiatrists, myself included, to achieve changes in memory processing in patients with post-traumatic stress disorder (PTSD). The effect of EMDR on the brain has been demonstrated by the use of functional MRI recording. However, both of these treatments require trained practitioners, and they have limitations in terms of cost, location and timing.
New treatments such as digitized neurofeedback can offer access to effective treatment, during which patients respond to a display of their own brainwaves or other electrical activity of the nervous system. By digitizing Neurofeedback and making it available via a smartphone, patients can use it at home without the help of a therapist or psychiatrist to deal with the mind’s emotional response to trauma. They can reset unhealthy and dysfunctional patterns that have developed over time due to stress, anxiety or PTSD, helping the brain develop new, healthy patterns over time, without the need for medication. In fact, there is growing evidence on the efficacy of neurofeedback, with digitized neurofeedback showing a drop of 4 or more on an anxiety scale for 86% of users and 74% reporting an immediate reduction in anxiety.
Looking to 2021 and beyond
There is no doubt that technology tools enabling assessment and customized treatment to the individual needs of the patient will play a vital part in the future of mental health treatment. The barriers patients experience to enter into the NHS services is high, exacerbated by COVID-19, which has directly increased levels of stress and depression among people treated by GPs and social services. Currently, there is a limited number of non-drug treatments showing any effectiveness for treating PTSD and anxiety.
Digital options for mental health assessment and support will have to become more widespread - much as they have for physical health - bringing effective treatment to more people in need. Doctors have a responsibility to look into the potential benefits and communicate them to patients, and work collectively to decide on the best treatment, personalized to their needs. GPs and psychiatrists can employ technology to enhance their own assessment and treatment practices (measuring cortisol or sweat levels, holding teletherapy sessions etc.). They must also be vigilant in terms of new treatments, grounded in academic or empirical use, and educate patients on the benefits of evidence-based autonomous digital therapeutics options they can safely and affordably use at home. Only by keeping the dialogue open, investing in new ideas and exchanging learning can we innovate, and help develop the next level of mental health treatment.
Dr Michael Bott is a consultant psychiatrist and board director/early investor at SPHERE