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The Doctor is On (the Internet)

June 28, 2013 - 0 Comments


By Jason Kohn, Contributing Columnist

Reading through the statistics on mental health is enough to make you, well, kind of depressed.

According to the National Institutes of Health (NIH), an estimated 26.2 percent of American adults – more than one in four – suffer from some form of mental illness each year. Nearly 10 percent of the U.S. population – nearly 21 million adults – suffer from a mood disorder such as depression or anxiety, and about 6 percent live with a serious mental illness that significantly impedes their ability to live and work.

And according to the World Health Organization, the numbers are just as dire globally, with more than 450 million people worldwide suffering from mental illness.

At the same time, many people with mental illness go untreated. An NIH survey found that just over half of U.S. adults with serious mental illness receive treatment. And this lack of care has real economic costs. According to the National Alliance on Mental Illness:

Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives; The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.

Why does such a big public health problem go untreated so often? Part of the answer lies in our continuing stigmatization of mental illness, and a reluctance of people suffering to seek treatment. But an even bigger problem is a lack of access to mental healthcare professionals. As Camille Laudicina wrote in the Billings Gazette:

The lack of availability stems from the shortage of mental-health care providers and the unequal distribution of those providers. Psychiatrists are in short supply across the country, especially in rural settings….

Access to care not only means the ability to travel to seek mental-health services but also includes having the means to pay for those services. Obtaining care in rural areas may require traveling several hours for a single visit. This may take time away from work, and traveling long distances can be costly.

Technology may not be able to erase the stigma of mental illness, but it can certainly erase many of the barriers to accessing care. And a number of companies are now seeking to do just that by providing mental health services anywhere, in the privacy of your own home, online.


Telemental Health

Health economist Jane Sarasohn-Kahn published a report last year for the California HealthCare Foundation on the growing mental healthcare options available online. The report details a number of interesting applications emerging in this space, including:

  • Online counseling
  • Computer-based cognitive behavioral therapy
  • Mobile apps that help people track moods and manage stress
  • Virtual reality-based therapy
  • Using social networks for group therapy and support

As Sarasohn-Kahn writes:

…the emerging array of technology-enabled psychotherapeutic interventions are expanding access to free and low-cost care for people with mild-to-moderate depression. Web-based interventions come in a variety of forms, from static-information websites to online therapy, patient-led support groups, and interactive multimedia therapeutic programs.

Importantly, some of these new platforms and formats, as well as their business and privacy characteristics, might help overcome some of the traditional barriers to mental health care.

The report provides an excellent survey of the range of applications out there, and is worth checking out in its entirety. Also worth checking out is the International Society for Mental Health Online, which is dedicated to promoting the development and use of online technology to aid mental health providers and patients.

Connecting with Providers Online

Another fascinating innovation in this space are new companies using the Internet to connect people to mental health services more conveniently and discreetly.  Stephanie Buck at Mashable recently wrote about one such company, TalkSession. In many ways, the service works like an online dating service — asking patients to provide information about themselves, and then matching them with the right providers and services for their needs.

…patients will be able to use TalkSession to search for therapists that match several criteria, such as location, insurance and specialty…. patients will begin by filling out a 15-part questionnaire to match them with the best available professional. Choose whether you prefer a male or female therapist, whether that person is open to alternative treatment plans, and even whether he or she likes the same books as you. The survey mimics the traditional intake exam most patients must complete before being matched with a therapist. From there, TalkSession’s  HIPAA-compliant algorithm will select a pool of ideal therapy solutions. Patients may opt for a treatment plan in their area or — if they’re one of the 80 million Americans who lives in an area too rural for mental health care — they’ll be able to check in from a laptop or tablet.

Expanding Access

Will solutions like these solve all our public health problems around mental illness? Likely not, but they’re a good start. And when extrapolated worldwide — especially to developing economies — the implications are potentially profound.

Kate Torgovnick of the TED Blog recently highlighted this problem in discussing the work of mental health advocate Vikram Patel:

If you translate the percentage of psychiatrists in the population in the United Kingdom to India, you’d expect to see about 150,000 of them. But in the world’s second most populous country, the actual number of psychiatrists is closer to 3,000. The situation is as dire in other countries, too. In Zimbabwe — a country of nearly 3 million — there are only about a dozen psychiatrists, almost all of them practicing in the same city.

In the connected future, telemental health could be a way to help literally millions of people who are suffering, who have no other way to access treatment. It’s a long way off, but if we get there, that will be something we can all feel good about.

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