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Using Technology for Mental Health Treatments

Mental illness is common and disabling but the evidence is that fewer than half of people seek any treatment and few receive any help from specialized mental health professionals. In Canada, there are long waiting lists to see psychological therapists face to face despite the importance of non-drug therapies. One way to address this problem is to use computerized e-therapies which deliver structured mental health treatment via a computer. Dr. Simon Hatcher, Psychiatrist at The Royal's Community Mental Health Program and Vice Chair of Research for the Department of Psychiatry at the University of Ottawa, lead a discussion about the role of technology in mental health treatment. Highlights include: the effectiveness of online mental health treatments and opportunities for innovation and policy change in field of mental health.

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Using Technology for Mental Health Treatments

  1. 1. Using Technology for Mental Health Treatments Presented by: Dr. Simon Hatcher March 24th, 2016
  2. 2. 2 Are computerized therapies the way of the future?
  3. 3. 3
  4. 4.  First healthcare revolution 1850 to 1960 – antibiotics, advances in physiology and anatomy  Second healthcare revolution 1960 to 2000 – stents, transplants, randomized controlled trials 4 Historical Perspective
  5. 5. □ Driven by: □ Citizens; □ Knowledge; □ Personal computing focused on patients. □ Personalised medicine - usually genes but also applies to habits. 5 The Third Healthcare Revolution
  6. 6. Current Healthcare Landscape Problems in Healthcare Organizations Harm Waste Variation Inequity Failure to prevent Challenges to be Addressed Rising demand Increased need Financial restraints Carbon restraints 6
  7. 7. 1. First generation □ “Books On-Line” 2. Second generation □ Some on-line interaction □ Complete questionnaires and answer quizzes □ Learning by gaming (SPARX) 3. Third generation □ Integration with mobile phones, email, and/or smart devices 4. Fourth generation □ Smart environments and “mobile therapists” 7 E-Therapies
  8. 8.  No waiting lists.  No stigma.  Can be tailored for specific groups.  Addresses work force problems.  Cost effective?  Better?  New treatments? 8 Use of e-Therapies in Mental Health Treatment
  9. 9. 9
  10. 10. Trial in New Zealand 12 63 participants Most completed only two or three sessions Fewer appointments 3 vs 4 with mental health services
  11. 11. Canadian Trial of The Journal • Recruited 84 people • Mean baseline PHQ-9 15 • Much better adherence to program 2/3 completing six weeks • Results due later this year 13
  12. 12. 14 Canadian Trial of The Journal “The Journal is my mirror - in my 56 years this is the first time I’m seeing myself inside and out."
  13. 13. 15 Canadian Trial of The Journal “I am grateful to be a part of the e-Therapy Program… With the guidance and support from my husband, you and the team, all my family members are seeing a huge change in me…I’m putting things behind me and moving forward. I’m looking at the positive. I know I’m not alone in this world. I’m so grateful to be alive, and so grateful to be working with you.”
  14. 14. 16
  15. 15. 17
  16. 16. 18 http://www.ehub.anu.edu.au/welcome.php
  17. 17. 23
  18. 18. 1) Samples Used: “community” versus clinical are often self selected. 2) Control Group Used: waiting list or treatment as usual. 3) High Drop Out Rates: 60-80% but this is comparable to other psychotherapies. 4) Little information available about acceptability or feasibility. 27 Limitations of Previous Randomized Controlled Trials (RCTs)
  19. 19. For people with persistent subthreshold depressive symptoms or mild to moderate depression, consider offering one or more of the following interventions, guided by the person's preference: • individual guided self-help based on the principles of cognitive behavioural therapy (CBT) • computerised cognitive behavioural therapy (CCBT) • a structured group physical activity programme. 28 Effectiveness of e-Therapies
  20. 20. • include an explanation of the CBT model, encourage tasks between sessions, and use thought-challenging and active monitoring of behaviour, thought patterns and outcomes • be supported by a trained practitioner, who typically provides limited facilitation of the programme and reviews progress and outcome • typically take place over 9 to 12 weeks, including follow-up. 29 Effectiveness of e-Therapies
  21. 21. 30 Virtual Mental Health Clinic
  22. 22. 31 Virtual Mental Health Clinic
  23. 23. □ Not limited to replicating face to face therapies. □ Scope for innovation - gaming, use of social marketing. 32 Opportunities for Innovation
  24. 24. □ Issues with evidence, content and privacy. □ Use of ACHESS with male Veterans in the USA to treat substance abuse. □ Development of a smartphone application to supplement face to face therapy after self- harm. □ RCT to be launched by end of 2016. 33 The Use of Smartphone Technology
  25. 25. 34
  26. 26. □ Useful in treating phobias and anxiety disorders. □ In the future, possibility of reliving the past. □ Other uses include: Conversation Skills Training Assertiveness Skills Training Emotion Expression Skills Training 35 Virtual Reality
  27. 27. Google Glasses: provide “reality based feedback”. 36 Wearable Computing
  28. 28. □ Prompts to take medication □ Therapeutic robot animals □ Mind exercises and communication 37 Robots Paro Robot
  29. 29. □ Use of Brain Stimulation □ Memory Chips 38 Brain Implants
  30. 30. • Netflix • Real time patient feedback • The power of groups • Social media surveillance 39 Big Data and Social Media
  31. 31. 40
  32. 32. ☐ Reinforce inequalities: ☐ Issues of access ☐ Language ☐ Limited evidence of effectiveness ☐ Ethics of monitoring ☐ Rapidly outdated/costs ☐ Privacy and risk issues ☐ Seductive ☐ Regulation □ No mechanism for rolling out online treatments including: □ Budgetary decisions □ Integration into existing clinical pathways □ Who would “manage” it 41 Problems with New Technologies
  33. 33. 42
  34. 34. 43
  35. 35. □ Person centred □ Scalability □ Quality assurance framework □ Research □ Knowledge translation and exchange 44 Opportunities for Policy Change
  36. 36. IIn 45 □ Integration with existing health and technology policy □ Integration with existing health services □ Sustainability □ Privacy and security Opportunities for Policy Change (2)
  37. 37. 46 Questions or Comments? Dr. Simon Hatcher Email: simon.hatcher@theroyal.ca Twitter: @shatchernz Blog: https://shatchersite.wordpress.com/

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    Jul. 31, 2017
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    Feb. 22, 2019

Mental illness is common and disabling but the evidence is that fewer than half of people seek any treatment and few receive any help from specialized mental health professionals. In Canada, there are long waiting lists to see psychological therapists face to face despite the importance of non-drug therapies. One way to address this problem is to use computerized e-therapies which deliver structured mental health treatment via a computer. Dr. Simon Hatcher, Psychiatrist at The Royal's Community Mental Health Program and Vice Chair of Research for the Department of Psychiatry at the University of Ottawa, lead a discussion about the role of technology in mental health treatment. Highlights include: the effectiveness of online mental health treatments and opportunities for innovation and policy change in field of mental health.

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