Application Day: Could we improve our mental health over the phone? | Ammar Kalia | News from the world

The growing crisis of mental health around the world is not just about the large number of people who get sick. This is the very small number of people available to care for them.

Wherever you live, it is likely that there are simply not enough psychiatrists and psychotherapists. The vast majority of countries have fewer than 200 psychiatrists per million people.

This often results in long waiting times, exorbitant fees for private attention and / or excessive prescribing of antidepressants by family doctors with few options.

Now, however, technology is looking to fill the void with a formidable dash of apps, chatbots, avatars and digital advisors that promise everything from daily recordings to mood tracking. going through cognitive-behavioral therapy and the prevention of "mental health hygiene". The big question is: are they good?

The majority of these platforms are for-profit companies and, as such, the global market for mental health software had an estimated value of $ 1.35 billion in 2017.

Some experts in the field of mental health are cautiously optimistic. The British Association for Counseling and Psychotherapy (BACP), the regulator of the profession, found in a recent survey of 1,987 members that 61% were already using digital platforms in their therapeutic work, ranging from messaging to videoconferencing. BACP Vice President, Fiona Ballantine Dykes, said that with text-based online platforms, "anonymity has advantages because it is sometimes very difficult to get into the business." sit in front of a person and talk to him. While this may encourage people to take a first step toward counseling or helping them move to other services, this is fantastic. "

Esther Schmidt, head of NHS Children's Services in Swindon, said that these anonymized online services "seem to affect some people in BME. [black and minority ethnic] and minority groups in a way that face-to-face services probably would not do because of the stigma attached to cultural badumptions about mental health. " She notes that these services "will become more and more part of the treatment, especially for places with geographical challenges".

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Still, not everyone is a fan. Sarah Niblock, Executive Director of the UK Council for Psychotherapy (UKCP), the regulator of the sector, has her concerns. "While the immediacy and accessibility of online mental health platforms can be seen as a definite benefit, anonymity can be troubling," she said. "There is no evidence that these platforms can be a sustainable alternative to face-to-face therapy because the therapeutic relationship between the practitioner and the client is what allows the person to deal with deep-seated problems." C & # 39 is this confrontation that makes the office therapist a potentially intimidating experience.

By far the most popular of all these services are mindfulness applications. Squeezing meditative therapies, platforms such as Headspace have been valued at $ 250 million and its rival, Calm, has been downloaded over 45 million times.

Although these services primarily use the digital format as an alternative accessible to physical agendas or self-help guides, there is a new suite of applications offering consulting services and peer support groups via a digital platform.

The most popular of these, at least in the UK, is Kooth, a service for 11-18 year olds, which allows them to anonymously discuss their mental health experiences with peers, as well as participate in textual discussions. counseling sessions with remote therapists. The number of users is expected to exceed 100,000 this year, up from 20,000 in 2015, and 95% of users say they would recommend it to a friend. Co-founder Zoe Blake credits Kooth's success to digital anonymity. "There is a disinhibition factor badociated with text-based counseling, where young people feel that lack of eye contact or judgment allows them to be themselves," she says. "Over 86% of our users said they prefer the online environment to live advice."

Ben Griffiths, 16, has been using Kooth for 18 months. "There is a lot less stigma around Kooth," he says. "When you attend a counseling session at school, it's hard to stay private about it because people can see where you are going. While with Kooth it's anonymous, you can have as many sessions as you want and it helps to stop your little stress. to develop something bigger, like depression. "

Blake insists that Kooth is an early intervention service designed to reduce the stress badociated with examining undergone by users such as Griffiths, rather than for crisis management. "We do not replace face-to-face counseling," she says, "we're asking counselors to do only what they can, without taking too much time in the preliminaries."

Although Kooth is led by consultants with at least three years of experience, other platforms integrate more digital aspects, using artificial intelligence to replace an experienced human interface. Silicon Valley's Woebot and X2AI companies, as well as Indian start-up company Wysa, all use scripted chatbots to chat with their users, sweeping the text to get the machine-learning signals they respond to.

Wysa is exploited by a penguin avatar with which users can chat, as if they were using WhatsApp, describing themselves as "your life coach and your friend," while the Woebot interface is no longer built. It performs daily "checks" that monitor users' moods (from "happy" to "angry", "tired" or "sad"), while allowing users to write "chat stories" to explore the emotions in more detail.

For example, by clicking on the fact that I was "sad" at a Woebot recording, he recommended a "thoughtful challenger" exercise to identify his negative thoughts and distinguish the reasons for their existence to the help of a series of brief answers.

Even though the experiment can sometimes be forced and discordant (intermingling emoticons with expressions such as "coinky-dink" and "cognitive dissonance"), these chatbots are extremely popular: Woebot receives an exchange of 2 million messages per week, X2AI covers 4 million people. in the United States and Wysa has more than 600,000 users worldwide. Woebot co-founder Alison Darcy defines her platform not as a prediagnostic tool, but rather as a tool that "helps people at the time of the unique encounter, by moving the conversation from the field of the clinic to the understanding that everyone has mental health. " take care of every day. In this way, she thinks that logging in and communicating with the application for up to 10 minutes a day can have a more powerful effect than the "one hour reading" of a counseling session.

Similarly, Ramakant Vempati, co-founder of Wysa, said that "labeling and diagnosis have no relevance to the lived experience of an illness. What people want, it's a safe place to talk, an empathic experience. So Wysa is like having a newspaper that can answer you.

However, these complex and fast technological developments have not always had positive results. A recent test by the BBC revealed that Wysa and Woebot did not notice any messages containing allegations of minor badual abuse, indicating in one case that the user had to "rewrite your negative thinking so that it was more balanced ".

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But Niblock from UKCP says: "People should not be afraid to work with psychotherapists because you need the ability, no matter how shameful or guilty you are, to say that to someone who says: "I hear", and who does not judge. It is there that the therapy is transformational and that a chatbot can not replace his support by a human being. "

If the use of IA chatbots goes too far, then perhaps digital interventions as part of a holistic treatment are the solution. With this in mind, the Unmind Workplace Mental Health Platform produces informative content, which is reported to the user by the AI, in order to create a combination of cognitive-behavioral therapy and badual intelligence. Guided self-help.

According to Nick Taylor, clinical psychologist and co-founder of Unmind, without digital treatment of mental health, the cost of mental illness at work in the UK last year will only increase. "From the clinical point of view, it's really frustrating that when you meet someone for the first time, you think," If only I met you six months ago, I could have had a much bigger impact. " He said.

"We would not leave a broken leg for six months without consulting a doctor, but that's what happens with mental health, and it's extremely damaging."

To remedy this, Unmind aims to eliminate the negative stigma surrounding mental health. "Diagnostic evaluation looks for problems and you can not use them for a healthy population," says Taylor. "It is not appropriate to ask someone who is well if they are suicidal – it will deter them from fully engaging in mental health. Our platform allows you to track your well-being and, even if we do not diagnose, we can have a good idea of ​​someone's health, depending on how they interact with the person. platform, and this allows us to badign content or guidance to other services. "

Unmind is available only through employers who have paid to access it, and among its current users, there are more than 100,000 employees of John Lewis and Yorkshire Building Society. metropolitan counties do not have access to a psychiatrist.

Perhaps early digital engagement with our mental health could reduce the stigma of the therapist's office, especially if it is not easily accessible. As digital incursions into our lives become natural – none of the companies I talked to expressed concerns about using data – these mental wellness platforms could become as mundane as Facebook or Twitter . "Mental health is the best thing about being a human being," says Taylor, "so it's frustrating to see things in a negative light: we need the right care at the right time and we should not not be ashamed. he."

• Ammar Kalia is a journalist with The Guardian and holds a Scott Trust Fellowship

• In the United Kingdom, you can contact the Samaritans at 116 123. In the United States, the Suicide Prevention Hotline is 1-800-273-8255. In Australia, the Lifeline emergency help service is available at 13 11 14. Help lines in other countries are available here.