As we head into the final quarter of this most bizarre year, anxiety and depression are palpably on the rise everywhere. Worldwide, social isolation brought on by stay-at-home and physical distancing measures, fear of contagion and grief for lost loved ones, compounded with loss of income and unemployment on a massive scale have exacerbated a brewing global mental health crisis.
A recent CDC study found that between April and June of this year, 40 percent of American adults reported elevated symptoms of mental health conditions associated with the coronavirus.
The pandemic has thrust mental health into the center of the global conversation. The exploding demand for mental healthcare services prompted by the global health crisis is not being met, not in quality nor in quantity --there simply aren’t enough therapists to help everyone. Even the ones that are working are feeling burnt out.
Amid this tremendous need to provide care for millions of people suffering from depression, anxiety and other mental health problems, psychotherapy itself is faced with an existential question: can therapists continue basing their care on gut feeling and training alone, or do they start using software and data to better inform their decisions? For psychologists, the choice is far from easy.
Generally speaking, therapists tune in to their training, experience, and intuition when working with patients. They make decisions based on their memory and impressions, which are, inevitably, subjective. For the most part, they reach conclusions and issue recommendations without any systematic objective measurements that could help them further assess how a patient is progressing, and whether therapy is actually helping. As therapists, we don’t have enough good data on what happens during our 50-minute sessions with patients, and no objective way of summarizing events even if we capture them.
There’s no way to scale that. Especially not to the scale that this mental health crisis needs.
To be sure, many therapists have accelerated their embrace of technologies like video conferencing and chat apps, not only to keep their practices running and provide uninterrupted care to patients, but also to answer the diverse needs of their patients.
But while the pandemic has forced much-needed innovation in the way medical care is delivered --telemedicine is booming -- the mental health industry has lagged behind and remains underserved by technology.
While we’ve seen much progress in the empirical support for psychological treatment, some core aspects of psychotherapy have not changed dramatically since the late 19th century.
Clinicians still rely largely on physical proximity, conversation, clinical evaluation, and supervision in their practice. Barriers to innovation have included resistance to new technologies, and concerns about rapport, safety, privacy, and potential disruption to clinical workflow. There’s also unease about the financial and insurance aspects of mental healthcare, as well as continuity of services beyond state lines and other legal implications of providing virtual mental health services.
Mental health care has to innovate or it will fail in its most basic function: eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.
For a clue of where to start, mental health clinicians just need to look at what their general medical practice colleagues are doing around the world: adopting data-led decision support tools that enable caregivers to see the whole picture of their patient, and not just what’s in the hastily-scribbled notes in between sessions.
Data could help us tap into factors such as engagement, to predict whether a patient will show up to the next appointment or cancel two hours before; we could more accurately track whether clients are adhering to treatment advice. Voice recognition and analysis software could help therapists process sessions on a deeper level, and make our lives easier by automating a lot of our manual tasks, which will, in turn, allow us to focus on our clients, to be more present. Think of it as a form of supervision where you gain a wider perspective. If a session is recorded and broken down into measurable components, therapists could, for example, look to see where they started to drift, or where they interrupted or didn’t pick up on something in real time.
Just as primary care physicians pull up patients’ blood work on their electronic medical record (EMR) prior to appointments, therapists now have the option to use tools such as data analytics, automated systems, online questionnaires, and digital platforms to provide better in-session care and critical check-ins between appointments. We could reach levels of knowledge we don’t currently have.
More weight could also be placed on patients’ well-being between appointments, where the current prevailing tradition is to ask patients to refrain from sharing information until their next session.
But with the right data --collected in real time and analyzed with full consent--clinicians could tap into information that is specific to a particular patient and their own individual challenges, and get indications of improvement or deterioration between sessions. Instruments such as patient-reported surveys or self-monitoring apps could better inform the clinician’s next meeting to meet the patient’s needs. We could identify struggles that would help us provide more precise, measurement-based care.
Technology could also help us address issues that we don’t necessarily have the bandwidth for during sessions, such as patients’ bouts of insomnia brought on by stress, especially in the limited time treatments that insurance companies are currently willing to reimburse .
As an expert on eating disorders, I regularly review my clients’ digital files, and arrive at the next appointment prepared more informed about their entire experience. Knowing I’ve reviewed their data is deeply meaningful to them as they feel seen, and reinforces their hard work.
But perhaps the strongest argument in favor of innovation in therapy is that patients have come to expect it. This is especially true of young people who are digital natives and for whom apps and data play a central and essential role in their lives. They wouldn’t go to a doctor who doesn’t pull up their electronic medical records, so why would they go to a therapist who doesn’t?
Mental health journeys are profoundly individual. If we could track patients’ progress using technology and gain data-driven insight into their trajectory, we would be better therapists and we’d be providing higher quality, more holistic care.
The writer is a clinical psychologist and Chief Clinical Officer at Eleos Health. She also serves as the Associate Director of Training at Palo Alto University Center for m2Health