Mental illness is THE public health crisis of our time, greater in terms of personal and economic costs than any other disease, dwarfing cancer, diabetes, and cardiovascular illness. Half of us Americans are at risk and likely to suffer from one of these problems in our lifetime. The global economic burden of mental illness over the next decade has been estimated at $16 trillion. Yet, this is only the tip of the iceberg because half of us never seek treatment – 45% say price is a barrier and 40% say the stigma of mental illness is a barrier.
Digital health technology is the perfect disruptive innovation for this sorry state of affairs – it directly addresses these barriers by being instantly accessible, affordable, and private. Perhaps as importantly, with mental wellness in the palm of your hand, the dialogue around mental health could be reinvented. Instead of focusing only on illness and pathology, we could focus on the pursuit of mental fitness, making it as socially acceptable as improving physical fitness.
I don’t think this is just a nice dream. We are standing on the edge of a revolution and digital technology will be at the epicenter of that revolution. But we are uncertain how to move forward. Elsewhere, I have described this state as the Wild West, a lawless frontier, full of potential.
In order to realize this potential, we need goals, guidelines, and values. We also need to create a truly cross-disciplinary dialogue to fully understand the personal and societal implications of digital mental health, and how to work with the vast amounts of data this movement will create. Until we do so, digital mental health will be a revolution without a manifesto.
A manifesto should dissolve the past, reinvent the future, define and antagonize, inspire and provoke to action, spark community and presence. Here I outline what I believe should be six core principles of the manifesto, to guide the digital mental health revolution. Vive la revolution!
Focus on Translation. For digital mental health to succeed there must be translation between the analog and the digital, between technical innovation and scientific evaluation. For example, there are thousands of mental health apps on the market, but only a tiny percentage – fewer than 1% – have ANY evidence base. Science is the best way we have to figure out which digital health tools work. It’s how we find the signal in the noise. Yet, this translation requires that people on both sides of this equation think outside their boxes. Technologists need to think randomized controlled trials and researchers need to think nimble science. Creating more academic-corporate partnerships with vision and gusto will increase innovation, reach, resources, and reality base on both sides.
Personalization. We know that one size does not fit all – in mental health as in most things. We have long talked of personalizing mental health treatments in Psychology. Without a perfect understanding of how and for whom mental health treatments work, we are far from this goal. Yet, while we shouldn’t create an unrealistic standard of everything being personalized, the massive amounts of data created by our digital signatures could move us closer towards data-driven personalization of mental health interventions. Utilizing these data in effective but responsible ways must be a core goal of the digital mental health revolution. Personalization could also provide a new platform for overcoming racial, gender, and cultural insensitivity in our treatment approaches –personalization must be based on who we are as people.
Control in the hands of individuals. We expect to self-curate our lives – our self-image, our social network, our information, our entertainment, the tools we use to navigate the world. Why should mental health be any different? We must create a play-list or Netflix model for self-curating mental wellness tools. At the same time, we need guidelines and standards, a balance between the prescriptive from professionals and personal choice. This major challenge is the gorilla in the room. How do we insure privacy while maintaining treatment integrity? How do we avoid using the carrots and sticks of “behavioral design” and gamification in controlling ways that treat individuals like rats in a maze?
Disruptive innovation. The digital mental health tools that populate the field must be truly disruptive, drastically increasing the accessibility and adoption of mental health diagnosis tools and interventions. To do this, we must first work out machine learning technologies combined with electronic medical records to improve diagnosis, treatment recommendations, and treatment delivery. Second, mental wellness tools must be in the palm of every hand. To do this, we should leverage targeted treatments that are brief and low-cost, and identify portable “active ingredients” that can be translated into many digital and cultural contexts. Therapy is not always appealing, so we must build products that are “sticky,” sophisticated, and aesthetically inspiring.
Attack stigma. Mental illness is among the most pervasive and potent of social stigmas. Mental illness is not contagious, but we fear it as if it were. The mentally ill are NOT more likely to be violent, and yet this is assumed. As long as mental illness remains a sign of disgrace and shame, people will avoid seeking help because it makes them feel broken – perhaps beyond repair. Digital mental health can’t fix all this, but it will shift the dialogue towards mental wellness rather than pathology, on building mental fitness rather than being broken. It will harness our desire for self-disclosure and “being seen” on social media to better overcome the silence that drives shame.
Understand the costs and benefits of technology. Lest this blog post come across as an ode to technology, let me stop you right there. Technology is by definition the application of scientific knowledge for practical purposes. If the technology that could transform mental healthcare was hydraulics, or kundalini yoga (and I’m not counting these out) I’d be all for it. At this moment in time, however, digital technology seems most likely to drive real innovation. But we don’t yet grasp the costs and benefits of these technologies. What does our “brain on technology” look like? What is the opportunity cost of being obsessed with and absorbed in our mobile devices? What is the impact of digital burden, of never making time for mind-wandering? We don’t know, and so we must walk a careful line between technophobia and technophilia, avoiding both.