Industries the world over are being disrupted by new technologies. The health care sector is no exception. From a proliferation of on-demand digital mediums for accessing and delivering treatment, to the growing use of e-payments, algorithms and AR, the clinical experience of patients and practitioners is changing. My aim is to discuss the effects of actual and potential digital developments on your practice - both from the clinical and business aspect.
Think to how Airbnb has turned the world of hotels on it's head. Today it has over 4 million property listings which is more than the top five hotel groups combined. How did the likes of The Hilton, Hyatt and Marriot get supplanted by a start up that is now valued at $38 billion? The answer is that technology has been harnessed in ways that have disrupted an entire industry in a short space of time. Similar examples are famously (though more slowly) unfolding in sectors such as the car industry. Professional services have not been untouched - think how cash machines have replaced many bank tellers, software is replacing accountancy services and translation services are being automated.
Brett King author of 'Augmented' anticipates that in the next 20 to 30 years more will change than in the last 1000 years. The healthcare industry is also being transformed before our very eyes and that includes the sub sector of mental health. What place will psychology have in our 'Smart World’?
Optimistically King argues that with the decline of some professions to automation, other areas will see an increased need. I was pleased to see 'Psychology, Counselling and Therapy' among the list of jobs that he believes will endure. My view is that part of the rise of mental health issues is due to disconnection and lack of supportive, in-depth relationships. Although many apps and digital robots are emerging that might offer to replace therapeutic intervention, I strongly believe that the need for humans to administer or deliver these services will remain and grow.
There are four areas in which technology can be seen to change the face of psychology. Diagnostics, Search, Treatment and Data.
1. Diagnostics. There is a proliferation of research and development in physical health diagnostics, leading to a range of devices that can be applied to humans to measure the state of their physiology. These cluster around sensors or wearables (watches, bands) that can be applied on the body, digestibles which can be ingested and remain internal, and carebots which like a nurse might be able to measure vital signs. Combined with CT scans, it is likely that some of these devices will be able to detect signs related to stress (pulse), PTSD, addiction, depression and other conditions. Digital diagnostics are improving drastically, and are likely to be extended to mental health markers too. In addition to measurement, such diagnostics can be used in preventive mental health care. Companies such as 'Beyond Verbal' employ technology to detect emotional traits such as arousal levels, temper and mood. These can be added to personal assistant devices via API.
2. Search. Assuming that humans continue to be the ones delivering psychological treatment, the way that patients/clients reach practitioners is changing because of technology. Marketplaces for psychological services are proliferating. Websites that amalgamate individual treatment providers mean that clients can search for support directly without needing a third party recommendation. Algorithms such as the one I use on my platform https://harleytherapy.com are designed around years of clinical indicators about what makes a good therapist, and presents the more relevant and recommended therapists to a person searching for therapy. Taking ranking factors such as the therapists responsiveness, relationship duration and client reviews, this greatly improves the chances of a successful therapeutic match.
3. Service delivery. The way treatment is delivered is changing rapidly. Traditional psychotherapy takes the form of a 50 minute session held at the same time each week.
Many services have moved away from this, instead offering the likes of on demand support including email and text message chats. Computerised therapy is also available in different formats and approaches (particularly CBT), although with lower efficacy compared to face to face services. Other mediums such as augmented and virtual reality are being trialled, as are 'therapy robots' run by artificial intelligence. The later is exciting in the respect of ongoing and iterative learning - session content can be fed back into the system to adjust subsequent interventions. However, my view is that although such services will continue to be developed, the trials will show that the human interaction will lead to the most long term improvements in psychological health.
4. Data processing. Data is heralded as the new oil, or currency. Information about individuals, their lives, habits and health is valuable on many levels. Collective databases that group data on people's mental health can be helpful in seeing what clients are searching for, what therapists offer, how wellbeing scores (like depression and anxiety indices) change by therapist or therapeutic approach and themes of mental health issues (which helps inform training needs in future practitioners). Data privacy is a concern here, but the use of pseudoanonymisation is increasingly standard and as robust a method as there is, given that there is no guarantee of complete privacy.
Lots of questions can be asked about the changes in these four areas:
Is quicker matching to therapists and instant appointments/help beneficial to clients, or is there merit in patience - giving time to reflect?
Is ‘shopping’ for a therapist acceptable?
Is reviewing therapists ethical?
Is remote therapy (and will VR be) as ‘effective’ as face-to-face? Even if so, isn’t the human connection different and does it matter?
In my recent trip to Silicon Valley as part of the London Mayor's International Business programme, I observed the zeal with which technology is helping to power products and services. And I note how the rest of the world is being modelled on the Valley’s adoption of technology. However, I also noted that Facebook's campus had a psychology centre staffed with actual humans. To me, the best we can currently hope for mental health care is for it's human core to be preserved but wrapped around by a blanket of technology to make the process smooth and more comforting for those taking up such services.
In summary, our profession is not immune to digital disruption. Technology is already transforming it and will continue to challenge traditional ways of working. Our task will be to anticipate new technologies, to continuously evaluate the impact on our work, and to adjust in a process of evolution, just as we have our entire history as a species.
Homo Deus - Yuval Noah Harari
Life 3.0 - Max Tegmark
Augmented - Brett King
Written by Sheri Jacobson, Director of Harley Therapy, https://harleytherapy.com
iCAAD Online 2020