The last seven days were a very different
week for me. I spent most of it in Portugal. Much of the time I was away from
wifi and any internet connection. This was both a blessing and a pain. A
blessing as I sometimes feel it does me good to go ‘off grid’ occasionally (and
it has been wonderful to be free of 24 hour general election and Brexit politics).
It was, equally, a pain, because it meant I was unable to easily contact my
family to let them know I was OK and to enquire as to how they were doing. On
reflection, now I’m back in the UK, having a disruption to my everyday life has
actually felt very refreshing.
I was in Portugal to present a
keynote paper at a mental health conference, where the audience were, in the main,
mental health professionals. It was the 117th presentation of my
mental health career as a practitioner/academic. Up to this week, I had
presented 116 conference papers in 25 different
countries, including China, US, Australia, New Zealand, Slovakia, Holland,
Japan, Germany, Italy, Czech Republic, Nigeria, South Africa and Iceland –
often making more than one visit to some of these. It was the second time I had
been asked to speak in Portugal. The first time was way back in 2002 at a
health and social policy conference. My focus on that occasion was a zeitgeist analysis
of the original NHS Plan, which had been published two years earlier.
Last
week, my paper focused upon resilience, recovery and research and the state of
mental health care in a digital age. Ironically, when I had been asked to speak,
I was unaware of just how difficult it was going to be to use digital
technology to maintain my everyday life activities! Drawing upon
international examples of best and emergent mental health practice, my paper argued
that new technology, particularly digital and information technology, can be something
good, and something to make our lives better. Equally, its use can also lead to
mental health problems, and problems for people of all ages. The paper explored
the possible negative impact on the individual, the communities they live in
and the potential for new ways of practising mental health care in the future.
Good mental health has been defined
by the World Health Organisation as: ‘A state of wellbeing in which every individual realises his or her own potential,
can cope with the normal stresses of life, can work productively and fruitfully... ...and as such they are able to make a contribution to their community'. In mental
health care, the concept of recovery is about supporting individuals to live meaningful,
satisfying, and purposeful lives. It’s not about ‘cure’. It’s about helping
people to enjoy good relationships, be engaged in satisfying work, and having opportunities
to grow and achieve personal goals. Likewise, the concept of resilience provides
a way to better understand how good mental health and wellbeing, strong social
connections, our personal attitudes, and interpersonal skills can help us deal
with periods of change or stress, and reduce the risk of experiencing mental
health problems.
Against this mental health context, digital
technology has begun to change our lives in many ways, albeit not always positively.
Who would have imagined back in 2002, we would be able to summon a
taxi, speak and see our family 1000s of miles away, shop and get the week’s
groceries or Amazon parcels delivered to your door, or pause live TV programmes
or stream 1000s of films directly to your phone? Don’t forget the first iPhone only
became available in 2007.
Strangely though, often our day-to-day experiences
of UK healthcare services has not changed much since 2002. Yes, we may be able
to book a GP appointment online, but most of us will still troop off to our
local primary care service for a face-to-face consultation. Even Babylon (the
online consultation service, GP at Hand) has only managed to secure 60,000 users
since 2016. In mental health, whilst there is a plethora of online
psychological therapies available, there are few live video clinical interventions
providing access to such therapies. The queues for brief interventions, such as
those provided by the Increasing Access to Psychological Therapies (IAPT) programme,
which has been tremendously successful, continue to grow ever longer.
Emergent technologies, such as that promised
by Artificial Intelligence (AI) bring with them some sinister side effects. The
harvesting of data, that many of us give so freely and without much thought,
forms the basis upon which many algorithmic and predictive decision-making programmes
are designed. Whilst it might be helpful for Tesco to shape its offers to me based
upon my shopping habits and preferences, other uses of personal data are rather
more worrying. Phenotyping (a kind of Tinder swipe left or right approach – not
that I know anything about this J), is beginning to catch on in many parts of
the US. It’s being used by mental health services to capture, analyse and use a
range of data. For example, the way phones are used, the tone of voice (yes
that microphone you have in your iPhone may not be entirely your friend), and
the length and timing of calls. The research suggests that the subtle aspects
of typing and scrolling, such as the interval between scroll and click, are
surprisingly good surrogates for assessing cognitive traits and affective
states in the same way as biological markers can indicate a particular physical
condition.
The promise of digital phenotyping is that
patients and clinicians will no longer have to rely on self- reported symptoms
in considering what might be an agreed way forward in addressing someone’s
mental health problem. However, in its purest form, these approaches offer
little privacy to the patient, and I guess for some people, the monitoring by
digital devices could exacerbate the feeling of being watched and trigger
paranoia. And there’s the rub. Digital technology can be a force for good, but
if we forget to keep the person at the centre of all we do and not the technology,
we might as well go back to being akin to Bentham custodians in a newly created
Digital Panopticon. And remember, just like me last week, it’s possible to switch
off Alexa….
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