‘We’ve seen a huge surge in use of technologies for mental health’: Dr. Stephen Schueller

Dr. Schueller: "Well, right now is a fascinating inflection point in that many therapists are being forced to use remote technologies to provide treatment. This includes basic technologies that allow them to transcend geography – telephones and video conferences, and other technology that allows therapists to transcend time and geography – like mobile apps and text messaging platforms.

"Anecdotally (I haven’t seen this data myself, but it’s been reported by lots of companies), we’ve seen a huge surge in use of technologies for mental health in the past week, with changes resulting from Covid-19.

"Outside of Covid-19 stuff in general, we’ve seen greater interest in technologies, with often 90 per cent of therapists reporting interest in using digital tools, but there’s a bit of a lack in terms of adoption, with those rates closer to 40-50 per cent. Some of this gap is just related to lack of training and experience, and I’ll say that anytime I give a workshop or webinar on the topic of using digital tools in one’s health practice, it’s extremely popular and well-attended, so therapists are thirsty for this knowledge.

"I also see more and more work being done to combine traditional services with technologies which I think is huge, positive progress. I firmly believe that 20 years from now we won’t be talking about digital health because all health services will have a digital component. The pathway to getting there is to think about ‘brick-and-click’ systems that redefine services with technologies. In this vein, it’s about creating platforms through technologies that facilitate optimal human connection and opportunities. We’ve been making a big push in our writing to acknowledge that the first wave of technologies were seen as products, but we need to realise the current wave is more ‘technology-enabled services.’

"Another shift we’re seeing is that a few products are starting to receive approval which is improving regulation and highlighting regulatory pathways for such tools, but it’s worth noting that a lot of our reimbursement is still based on ‘contact hours’. The technology-enabled services lens helps with this somewhat, but it is going to be a barrier to progress."

E&T: What kind of research have you been working on regarding tech and MH? What results are you seeing?

Dr. Schueller: "I do so much work in this space, but there are two things I’d like to highlight. We do a lot of studies surveying or interviewing consumers about their use of digital mental health, and across studies we consistently see about a third of people come back and talk about non-mental health specific technologies – Spotify, Facebook, Instagram, GoogleDocs, etc. At first, I thought this was a problem with how we were asking the question, but even if we changed the question, the responses were quite consistent. When we started to do more qualitative work, we realised people were leveraging these technologies to better their mental health, like making mood boosting playlists on Spotify, curating their Instagram feeds so they contained only positive and uplifting content and turning to it in times of need, and using GoogleDocs to track and counter negative thinking or reflecting on moments of gratitude.

"Despite all the media hype that technology is ruining our youth and their mental health, there’s an amazing potential of technology to connect, support and contribute.

"I’ve also been leaning hard into the idea that peers are powerful, and technology is a powerful way to facilitate peer collaboration. A lot is created that involves the burden of mental health issues and how we’ll never have enough professionals. Yet I think technology might be able to spin this as ‘a feature instead of a bug’, leveraging the fact that so many people face mental health challenges to help people support each other.

"In this vein, many people are well-intentioned, but lack training or knowledge in effective, science-backed strategies, so we’re trying to use technology to provide micro, on-demand training and support to help people support each other. This approach is very scalable and applicable to the wide variety of places people seek support in online spaces – forums, social media, online video games, etcetera."

E&T: Regarding Psyberguide, what kind of research must you do in order to collate and discover what app is best for certain mental health conditions?

Dr. Schueller: "I serve as the executive director of PsyberGuide so I oversee our activities, our team, and provide strategic direction. We have a team of staff and volunteers that are managed by our amazing project manager, Martha Neary. Essentially, we must identify, evaluate and disseminate information about digital mental health products.

"The identification and dissemination is done partially by our team, but also in close collaboration with partners like Mental Health America, and other organisations like the Anxiety and Depression Association of America, the Association for Behavioral and Cognitive Therapies, the International Obsessive-Compulsive Disorder Foundation, and a bunch I’m probably forgetting.

"Our team is trained to evaluate these products on three factors: credibility, user experience, and transparency around data security and privacy. It takes a while to train a team member before they demonstrate reliability on using the scales we’ve developed, but once they do, they rate each product independently and then it’s signed off by multiple team members before it is posted. We contact developers when we post a review of their product to solicit any additional feedback."

E&T: What do you think the future will be like regarding technology and mental health treatments? What would you like to happen?

Dr. Schueller: "I want everyone who wants treatment to be able to receive it. I think technologies can play a part in that puzzle, but obviously are not a panacea. Many people still lack adequate access to technologies to use these tools or do not have the digital literacy to be able to use them for health benefits. So there’s lots of work that has to be done in access and use, but when people go to digital tools I want to make sure they have the information they need to make informed decisions (like PsyberGuide) and the products they go to are high quality (which is why I continue to do work in this space).

"As I mentioned, I think use of technology in health will become more ubiquitous, but that doesn’t mean there will be one product that works for everyone or every circumstance. I think we’ll see a collection of science-backed products, but hopefully more consistency on how people are supported through those products. I’d love to see professions pop up to support people in using digital tools. John Torous’ group has talked about digital navigators and I think that’s a nice model. Yet I think expecting current therapists to become experts in technology is going to be a challenge and we’re going to need to train people to use these tools."

E&T: What has occurred in your field that has helped in MH treatment?

Dr. Schueller: "I’ll say I think we’re still early stage here, especially in this country [USA]. We’ve seen considerable advances in the use of digital tools to expand mental health services in other countries like Australia: Nick Titov’s Mindspot / eCentre Clinic has treated thousands of people using digital tools and has been a premier research laboratory advancing the science of what works here.

"We’ve seen similar initiatives in Canada and across Europe in their ImpleMentAll project. In the US, we haven’t seen as much catch on. People are using tools like Headspace, Talkspace etc, but we don’t have good numbers in terms of how much are people sticking with these tools or how much people are helped from them. We also do not have those numbers in psychotherapy more generally, but hypothetically the digital space makes us think we’d have an easier time getting those.

"Right now, I think we’re still in the world of a lot of potential and good ideas, but we need to implement it. I say this repeatedly, but I think the next five years of implementation should be ‘boring’. I think a lot of people are trying to swing for the fences and get a home run – virtual reality, digital phenotyping, chatbots. I think these technologies are great, but probably are a few years out from widespread use and effectiveness.

"One of the best digital tools I’ve seen for mental health is CrisisTextLine, which is a really simple idea: to train volunteers to respond to crises, use text messages to make it scalable, make it widely accessible and available, and use those messages coming in to mine and harness information and learning.

"Also, I’d just note that Europe and the UK is much further along with these things than us here in the States. The UK NICE’s guidelines suggest that digital treatments should be frontline treatments for depression and anxiety, and I think they’re taking that seriously. Yet those technologies they’ve been disseminating are simpler ideas – websites, mobile apps, and connections with providers through these platforms to support their use."