May International Neuroethics Society Webinar: Ethical and Societal Implications of Telepsychiatry and the New Era of Digital Mental Health

By Louiza Kalokairinou

Image by Forth Edge via Flickr
This piece is part of a series that will include discussions about the International Neuroethics Society (INS) webinars; these webinars are being hosted monthly throughout 2021 and feature various neuroethics topics.

This post is based on a webinar organized by the International Neuroethics Society, entitled “Ethical and Societal Implications of Telepsychiatry and the New Era of Digital Mental Health” and part of the Neuroethics Webinar Series. The webinar took place in the context of the 12th International Scientific Conference on Neuroethics and 7th Conference of the Italian Society for Neuroethics (SINe) on May 20, 2021. The panel discussion was moderated by Anthony Weiss (Beth Israel Deaconess Medical Center) and included three leading experts in this field: Nicole Martinez-Martin (Stanford University), Cynthia Sieck (the Ohio State University) and John Torous (Harvard University).

The COVID-19 pandemic has had a major effect on global mental health, causing stress, anxiety and feelings of loneliness and isolation. The increased demand for mental health care in combination with the disruption of in-person treatments caused by the pandemic has led to a surge in the use of digital mental health technologies. Currently, there are over 10,000 mental health apps available to consumers, which include remote cognitive behavioral therapy, guided meditation, mood tracking, and chatbots powered by artificial intelligence. The digital mental health market is rapidly growing, projected to reach $4.6 billion by 2026

In this session, the panelists discussed this rapid shift to digital care and its implications for the future of mental health care. The panelists recognized several opportunities and pitfalls, and reflected on how we can maximize the benefits of digital mental health in a post-pandemic world. Below are some of the key points discussed:

What is digital mental health and how has this field developed during the pandemic?

Framing the discussion, Dr. Torous [who has been featured in this blog before] described digital mental health as comprising, first of all, telehealth (synchronous and asynchronous) and, secondly, monitoring technologies. The latter category includes the collection of active data (e.g., data inserted by a patient when taking a survey) and passive data (e.g., data collected by sleep tracking devices). 

Even though the adoption of telemedicine in previous years has been relatively slow, the pandemic has forced providers and patients to utilize digital tools in lieu of in-person visits, increasing familiarity with digital health care. While all areas of digital mental health have grown tremendously over the past year, synchronous telehealth is the field that, according to Dr. Torous, has expanded the most. This is because synchronous telehealth is an extension of traditional in-person care and is based on an established practice and existing regulation. As a result, it faces less hurdles around its implementation, compared to asynchronous telehealth, which is still surrounded by a number of questions (not least being whether it constitutes clinical care or not and who can deliver it).

As underscored by Dr. Martinez-Martin, in addition to the provision of digital psychiatry in the medical space, there has also been rapid growth in the consumer space, reflecting the increasing demand for (digital) mental health care during the pandemic. Consumer apps like Headspace, which offers guided mediation and purportedly aims to help consumers reduce their stress levels, are used by millions and are sometimes recommended by physicians as an additional tool for patients. The growing demand in this area raises a number of ethical issues about how to properly approach and regulate these different models of digital health care and how the medical and consumer space could potentially work together. 

What are the upsides of these telehealth and monitoring technologies? 

Image by Ceibos via Wikimedia Commons
The accelerated adoption of digital health has made patients and providers and other stakeholders acknowledge its upsides, which include, among others, increased accessibility and opportunities for innovation in the field of mental health.

Increased access to health care was a benefit of digital mental health identified by all three speakers. Digital applications remove practical barriers of in-person visits, such as transportation costs, time required for in-person appointments, and lack of providers in rural areas. In addition, the relaxation of rules regarding the provision of telehealth across state lines and the expanded reimbursement offered for these services have further improved accessibility of mental health care services. In this regard, as pointed out by Dr. Sieck, telehealth and digital health technologies can be accessible by a large part of the population, meeting people where they are. 

Furthermore, research based on data collected by digital health tools may contribute to exciting developments in the way we approach, diagnose and treat mental health conditions. According to Dr. Torous, information from monitoring technologies can contribute to the development of a new functional nosology based on peoples’ lived experience. The ability of monitoring technologies to capture a large amount of data across environments and time may help us overcome existing challenges in understanding and classifying mental disorders and can contribute to the development of an alternative approach to the categorization and treatment of diseases. While the development of such nosology is still in a research phase and may not materialize in the immediate future, such research may ultimately help us rethink the concepts of mental illness, prevention, and allocation of time and resources to the benefit of patients and providers. However, as Dr. Martinez-Martin argued, developing a new nosology based on data from monitoring technologies may present numerous challenges in terms of validating these instruments, as well as in assessing what is considered a positive intervention and how to meaningfully implement these categories in a way that is beneficial across groups that differ in terms of race, culture, and socioeconomic status. 

What are the biggest risks of this shift to digital monitoring in mental health?

Two of the main ethical risks identified by the speakers are privacy and limitation in access due to digital divides.

Data related to mental health are considered to be more sensitive compared to other categories of health data, such as data on cholesterol and diabetes, as they can be particularly stigmatizing and could be misused by the government, employers, or other parties. Indicative of the sensitive nature of this data is a recent case in Finland, where hackers obtained personal data from 30,000 clients of a mental health startup and demanded ransom in exchange for not publishing private information from their therapy sessions. While this is hardly the first case of medical systems being hacked, what sets this case apart, according to Dr. Torous, is that personal data was weaponized against individual patients and not health care systems. Due to the nature of mental health data, security risks are more prominent, and we need to hold ourselves to higher standards with regard to their protection.

Image by Elf-Moondance via Pixabay
Dr. Martinez-Martin highlighted that currently there is not an appropriate system of data governance that strikes a balance between scientific and social benefits and possible risks. Despite some regulatory efforts (e.g., the GDPR in Europe and the CCPA in California) and increased attention on this topic, to-date, there is no comprehensive regulatory framework encompassing all types of data captured by monitoring devices. Risks related to privacy are pertinent both in the consumer and health care space, especially considering that de-identified data may be surprisingly easy to re-identify in the future. Such privacy risks may be particularly pronounced for marginalized groups and could result in further discrimination and stigmatization. 

Another risk identified by Dr. Sieck is that of unequal access to telehealth and monitoring technologies. Access to digital mental health often requires updated devices and some technical skills in order to be able to download and use the software. However, there are significant disparities in digital literacy and access to technology that create multiple digital divides: age disparities, disparities between urban and rural populations, and disparities between rich and poor. In this regard, promoting digital literacy and improving internet access across populations is crucial in order to reap the benefits of digital mental health care and avoid perpetuating existing inequalities.

What is the most important action to take in order to mitigate these risks and reap the benefits of digital mental health care? 

Moving forward, it is particularly important, as Dr. Sieck stated, to develop a way to systematically assess peoples’ digital skills, literacy and access to technology. This will help us understand more clearly the uptake of these technologies and develop strategies to bridge digital divides. Furthermore, Dr. Martinez-Martin highlighted the need to promote equitable access and design in digital mental health care in order to avoid perpetuating and exacerbating existing disparities. In this regard, it is essential to find models and frameworks that will enable us to use these tools in a way that will ensure that the benefits of digital mental health care are equitably shared. 

Digital mental health care, at this point in time, has gained unique momentum: more providers and patients than ever before are using these tools and acknowledging their value. What becomes apparent from this discussion is that if this shift is sustained in the post-pandemic era, it can lead to exciting innovations and advances in mental health care, as well as broader accessibility, especially for underserved populations. 

However, like many technologies, digital mental health care tools can be a double-edged sword: accessibility can be widened only if existing barriers such as lack of access to technology and low digital literacy among marginalized populations are addressed; harnessing data collected by monitoring technologies can lead to socially beneficial innovations only if we ensure that there are sufficient privacy safeguards. As such, mental health care is at a turning point. In order to ensure that the benefits of this digital shift are maximized and shared equitably, relevant stakeholders, including researchers and policymakers, need to explore and better understand the implications of these tools and address the ethical and regulatory issues stemming from them.


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Louiza Kalokairinou is a Postdoctoral Fellow in Advance Biomedical Ethics at the University of Pennsylvania. Her research interests include ethical, legal and social implications of biomedicine and emerging technologies, with emphasis on genomics, neurotechnologies, and direct-to-consumer health products. Louiza holds a PhD in Biomedical Ethics and Law from KU Leuven and has worked as a Research Ethics Officer for the European Commission.



Want to cite this post?

Kalokairinou, L. (2021). May International Neuroethics Society Webinar: Ethical and Societal Implications of Telepsychiatry and the New Era of Digital Mental Health. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2021/07/may-international-neuroethics-society.html

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