A blog by Elvira Perez Vallejos, Associate Professor of Digital Mental Health, Mental Health and Technology theme.
I recently attended a workshop at the Royal College of Psychiatrists to discuss and reflect on the impact of digital technology on the future of mental healthcare. This workshop was part of the Topol review which is aiming at preparing the NHS healthcare workforce to embrace current and future digital developments for mental healthcare.
This review is being led by Dr Eric Topol, an American cardiologist, geneticist, and digital medicine researcher, author of ‘The patient will see you now’ and ‘The creative destruction of medicine’ among other more clinical textbooks.
During the workshop, attendees were distributed into heterogeneous groups. My table included several mental health practitioners (three psychiatrists and a mental health nurse), a policy maker and a machine learning expert. We were asked to reflect on these questions:
1. How will digital technologies change roles and functions of clinical staff?
2. What are the implications for the skills required?
3. What will this mean for the selection, education and training of staff?
To my surprise, I did not have to defend or argue about the need to promote a basic understanding of how the digital economy works and its implications for users’ data privacy and security, the dangers of secondary data being sold in data markets, harm related to self-diagnosis and self-treatment. Nor did we discuss the use of unreliable smartphone apps (see Bauer 2017 for more details), the risks of persuasive design, or the need for human-centred design and co-production of new tech for mental health engaging and involving clinicians, service users and developers.
We all agreed about the need for a cultural shift in which data ethics and responsible research innovation (RRI) drives tech advances. One of the barriers that kept appearing during our discussions on the effective adoption of digital tech was the software licence issue.
I was not aware that NHS Trusts have to pay a substantial amount of money in order to be able to offer specific treatments to service users or analyse health data. If software were instead developed in-house or with taxpayer money, this should be open access and freely available within the NHS.
We also discussed the lack of research evidence to help us understand current and future relationships developed towards machines (i.e. avatars, robots, virtual human therapists and chatbots) designed to support or monitor peoples’ mental health. These new attitudes and human-machine relationships have a generational effect and younger people may place more or less trust on tech outcomes than older people.
This is an aspect that needs more research, specifically understanding the implications of these new attitudes on mental healthcare.
It was agreed that technology advances are moving fast; too fast for health services to cope with. And tech innovation cannot be slowed down and NHS services cannot speed up. This is a problem that will influence how training is delivered and medical curricula is updated.
Digital technology will force a rapid transformation of the roles and functions of clinical staff who will be expected to adapt quickly and cope with a constant flow of new solutions.
Bringing the digital into the NHS will require the training of staff on digital literacy, basic maths and statistics (e.g. to understand mental health algorithm-mediated outputs), and to become more multidisciplinary than ever before. The data analyst or natural language processing developer working alongside clinicians may become the expected norm.
I really enjoyed the whole discussion but what struck me the most was the realisation that ‘the digital’ can actually revolutionise psychiatric diagnosis. It was argued that mental health distress and difference is more fluid and dynamic than the DSM (Diagnostic and Statistical Manual of Mental Disorders) codes, a product influenced by the pharmaceutical industry.
Digital tech for mental health seems to highlight the issues embedded within the current diagnostic system and may offer an alternative perspective that can influence the future of psychiatry.