mH2 – the future of mental healthcare

Mental healthcare is often described as the Cinderella of medicine – overlooked, disparaged, and generally neglected. In the UK, mental healthcare is the single biggest item on the NHS budget (£12.16bn in 2010/11), but in practice this means that only about 11% of the overall spend is allocated to deal with 23% of the disease burden. Recent cuts have also hit mental healthcare significantly harder than e.g. acute hospitals, leading to a perfect storm of falling capacity and rising demand. Mental healthcare appears to suffer from the same stigma in policy circles as individuals with (e.g.) schizophrenia and bipolar disorder experience in private life. And just as stigma leads to worse outcomes for mentally ill individuals, the underfunding of mental healthcare leads to higher long-term costs for the NHS.

If things look bad at home, they’re a lot worse elsewhere. High-income countries like Britain and America spend an average of $44.84 per capita on mental healthcare; by contrast, low-income countries manage only 20 cents, and spend most of that on inpatient beds rather than more effective community care. Wealthy nations have one psychiatrist for every 11,640 people; the poorest countries barely have one for every two million. Undertreatment of mental illness is a problem everywhere, but it reaches epic proportions in the poorest countries, where as few as one in ten sufferers receive treatment.

Is there any sign of a fairy godmother to save the day? It’s certainly true that mental health has received more prominence in global health circles in recent years, with initiatives such as the WHO Mental Health Global Action Programme (mhGAP) taking place alongside anti-stigma campaigns and special issues of leading medical journals like The Lancet. As a result, greater awareness now exists regarding (e.g.) the effectiveness of existing treatments, the importance of community-based care, and the need to counter stigma. Policymakers are beginning to pay more attention to mental health, and some progress can probably be expected in the future.

However, the fairy godmother has a blind-spot, and that blind-spot is technology. The global mental health movement, quite reasonably, emphasises low-cost and easy-to-use mental health interventions, but errs by assuming that this necessarily excludes technological solutions. In fact, technology, particularly mobile technology, has the potential to make significant (and cost-effective) contributions to mental healthcare – especially in poorer countries, which have seen huge increases in cellphone usage in recent years.

In line with frugal innovation thinking, many existing capacities of tablets, smartphones, and even dumbphones can be repurposed to serve diagnostic, monitoring, and therapeutic functions. At the lower end of the scale, researchers at Oxford and elsewhere have shown that SMS and voice-calls can reliably be used to assess mental health status, deliver talking therapies (e.g. cognitive behavioural therapy, or CBT), and stimulate behavioural change. Higher-spec devices such as smartphones and tablets can perform the same functions in more user-friendly ways, for instance through multimedia apps, and can also draw on a wider range of sensors and capacities – e.g. accelerometers, GPS, and camera – to generate richer data and smarter interventions. The Mobilyze! system developed in Chicago, for example, utilises a machine learning algorithm to process 38 smartphone sensor values alongside user input to predict psychological status and deploy tailored therapeutic interventions for unipolar depression. Mental health and mobile health – a synergy I term mH2, or m-Health squared – already has the capacity to revolutionise the way we evaluate, monitor, and treat mental illness, especially in poorer countries where mental health workforces barely exist.

That’s not to say that things can’t get even better in the future. Before long, smartphones will deduce our emotional state from our social interactions and tone of voice, while wearable sensors will measure adherence to ‘smart’ medicines and gather important data on a range of factors relevant to mental health, including sleep quality, cardiovascular status, galvanic skin response, and even gait. (It’s been shown that people with schizophrenia have a distinctive way of walking, so it’s not implausible that Andy Serkin-style motion capture smart clothing could play a role in improving diagnostic accuracy in mental health.) Granular monitoring and smart, highly-personalised treatments – Big Data meets Quantified Self – are the future of mental healthcare, and that future will only be made possible by mobile technology.

In the meantime, though, what’s required is more urgency about developing and rolling out mH2 systems using existing technology. At present, most mH2 systems exist only as small-scale pilot studies, and there is a pressing need for governments to provide targeted R&D funding and strong incentives for large-scale development, trialling and implementation of mH2 interventions, and for policymakers and healthcare professionals to integrate mH2 solutions into existing care models across the globe. In medicine, there’s no such thing as silver bullets (or magic wands). But adopting mH2 will definitely help get Cinderella to the ball.

This article was originally published on The Guardian website

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