The Power of Technology in Mental Health Care

Mental illness is a widespread concern throughout the United States, and perhaps no group feels this more acutely than college students. Young adults aged 18 to 25 have the highest prevalence of mental illness of any age group–with 22.1% of them struggling with a mental disorder.[1] The impact of mental illness is far-reaching, costing the United States nearly $200 billion in lost earnings per year.[2] Moreover, when left untreated, mental illness can lead to poverty, homelessness, inappropriate incarceration, disability, and even premature death, among other tragic consequences. Yet, global annual spending on mental health is a mere $2 per person–and the majority of people with mental illnesses receive no treatment for it.[3] Mental illness is an urgent public health emergency that requires a comprehensive plan to increase the availability of treatment options. What is one potential new avenue of support? Treatment delivered to the device you’re using to read this article. Technology has become a powerful solution to the challenge of delivering accessible mental health care to millions who need it.

A particularly well-known use of technology in mental health treatment is in crisis intervention. The Crisis Text Line is an example of a successful service, with over 80 million messages exchanged since the startup launched in August 2013.[4] It has been used in every area code in the United States in the five years since its founding, and the service has even expanded to Canada and the United Kingdom.[5] More importantly, Crisis Text Line reaches the people who would not otherwise have access to help–19% of its volume comes from the zip codes in the lowest 10% by income.[4] Many texters also come from rural areas throughout the United States, where resources are more limited and difficult to access.[4] However, Crisis Text Line is not yet available in many regions of the world, including low-income countries. While 35-50% of severe mental illnesses, as defined by the World Health Organization, go untreated in high-income countries (which illustrates a need for more accessible services), 75-85% go unaddressed in low-income countries due to stigma, a lack of national programs or policies addressing mental health, and insufficient resources.[3] However, the idea of intervening in mental health crises through text holds promise and has been shown to be effective at a large scale.  

For those who need long-term support, such as ongoing therapy, online care options also show promise. Self-guided, internet-based cognitive behavioral therapy (CBT) has proven to be effective at treating depression.[6] CBT challenges negative thought patterns and works to reduce harmful behaviors. Since this therapy often involves exercises which focus on reframing thoughts and modifying behaviors, it can be delivered online. The availability of this therapy can make mental health care more accessible and affordable to people who need it. However, treatment adherence is a significant concern in a self-guided therapy, as the effectiveness of the therapy correlates with how many sessions participants engage in.[6] For instance, since the telling  symptoms of depression include low energy and a lack of motivation, it may be difficult for people with depression to participate in this therapy in a way that they would truly benefit from.[6] Thus, even though online, self-guided therapy can help in some cases of depression, and provides affordable care to people who otherwise would not have access to it, it is not the ideal treatment for everyone.  

Finally, a variety of apps that harness the power of positive coping strategies are available to support people with mental illness. These range from meditation apps to behavior trackers and journals. Many of these apps are free, and even those that require payment are available for less than $10/month. One of the concerns raised regarding the variety of apps available, however, is the lack of regulation surrounding them. As a result, apps can be widely downloaded and used without being shown to be effective at relieving symptoms of mental illness. Furthermore, concerns surrounding privacy must be addressed for any app dealing with such sensitive issues. The incredible popularity of apps such as Calm and Moodnotes, which have both hit the top rank in app downloads, makes a lack of oversight dangerous because users may forgo needed care by using the app beyond its intended purpose.[7] However, users’ positive ratings indicate that the apps likely help, and that their accessibility is a major benefit.

Technology-based support for people with mental health conditions offers affordable care to people who might not access treatment otherwise. That said, crucial concerns remain to be addressed, including the ability to bring these services to low-income countries, ensuring treatment adherence, and improving oversight. Nevertheless, compelling evidence has shown that these interventions can be effective at reducing symptoms and are viable at a large scale. Indeed, technology-based support may be the future of addressing the large-scale problem of mental health care.

References:

  1.    Mental Illness. (2017, November). Retrieved October 25, 2018, from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
  2.    Insel, T.R. (2008). Assessing the Economic Costs of Serious Mental Illness. The American Journal of Psychiatry. 165(6), 663-665
  3.    Mental Health Action Plan: 2013-2020. (2013). Retrieved October 25, 2018, from http://apps.who.int/iris/bitstream/handle/10665/89966/9789241506021_eng.pdf;jsessionid=45387C49F26C68AAF29F06977335AA81?sequence=1
  4.    Crisis Trends. (2018, March). Retrieved October 25, 2018, from https://crisistrends.org/
  5.    Crisis Text Line. (2018). Retrieved October 25, 2018, from https://crisistextline.org/
  6.    Karyotaki E, Riper H, Twisk J, et al. Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data . JAMA Psychiatry.2017;74(4):351–359. doi:10.1001/jamapsychiatry.2017.0044
  7.    Four Ways Technology is Helping Mental Health. (2018, May 23). Retrieved October 25, 2018, from https://digitalhealthtoday.com/blog/technology-and-mental-health/
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