The pandemic brought us closer to a digital world where even therapy can be obtained online, but how does it measure up to the traditional type?

Mental illnesses are common all over the world. One in three people will have a mental illness in their lives, according to estimates. While many mental disorders can be helped with care, having a mental disorder can be very hard on the person who has it because of the health problems they can have and the shame and exclusion that can come with it.

DMHIs (digital mental health interventions) are available to most people, even those from low-income groups, since about 85% of adults in the US own one. In fact, DMHIs not only make the mental health care system more effective, but they also help people who do not have time or are worried about privacy or cost get the help they need to get better. Despite the advantages of this type of therapeutic intervention, some factors mitigate against its use by patients in need.

There may be a number of reasons for low utilization rates, such as stigma and the high cost of services. One person whose life was changed by mental health shame is Thomas Eagleton, who was George McGovern’s choice for vice president in the 1972 election. Eagleton was not even on the first group, but he was a rising star. His election as attorney general made him the youngest person in Missouri history.

At least three times in the 1960s, Eagleton was treated for depression and given electroshock therapy. A group of Democrats asked Eagleton to step down, and he did. He pulled his name from the running for vice president 18 days after being chosen. His career went on for election to posts in his state and he died in 2007.

But shame regarding mental health still lingers today, despite yeoman-like efforts to educate people regarding it. No longer do we see those with mental disorders as needing to be segregated and untreatable, however.

One thing that still keeps people who want to get help from doing so, however, is that there are not enough mental health professionals to meet the demand. Many counties in the US do not have a single psychiatrist. Estimates are that 37% do not have a psychologist, and 67% do not have a psychiatric nurse practitioner.

Many of these mental health professionals work in cities, so many people in the U.S. cannot get mental health services. Up to 163 million Americans, or almost half of all Americans, live in areas where there are not enough mental health professionals.

A Question of Ethics

Mental health professionals can use digital tools and real-world data to help patients and make in-person meetings more useful. Using “channel switching” between digital and non-digital (face-to-face) treatments can help integrate the service. This is also known as “blended care” or “adjunctive therapy.” With this digital integration, in-person meetings are better connected to the real world, like “digital glue.” But there are issues that need to be considered, along with the availability of these services.

Catching and using user log data from health and wellness tools in apps and cloud-based services is known as “digital phenotyping.” Products and services based on digital wellness technologies usually include apps for mobile devices and, to a lesser extent, browser-based apps. They can also include services that work over the phone, text-based chatbots, and voice-activated chatbots. How do we ensure that this data is protected?

With informed consent, digital phenotyping is currently used in research studies. However, it will likely be used in more areas in healthcare and direct-to-consumer. Personal information about each person can be collected for digital phenotyping, and new health and risk assessment data could be made. Because the rules and ethics already in place for mental healthcare do not clearly apply to digital phenotyping, it is very important to consider the ethical, legal, and social effects it might have.

As you might expect, most literature focuses on technical issues rather than moral, legal, and social ones. This makes it harder to understand the more complicated culture and social factors that digital phenotyping technologies affect.

Different Outcomes?

Different DMHIs did not change the outcomes for depression, anxiety, suicidality, or drug use in adults who were scheduled for outpatient psychiatry treatments. All the interventions consistently reduced depression and anxiety symptoms, and there was not much proof that some were generally better than others. The results clarify that DMHIs could be used as extra-helpful tools in healthcare settings.

The benefits appear to be obvious, not only in terms of availability in areas with few mental health professionals but also that digital or combined therapies are effective and can be utilized by far more people than previously when only face-to-face therapy was offered. However, as is pointed out, there are ethical and regulatory concerns here, and I would also mention concerns regarding licensing.

Not all healthcare licenses provide someone with an approved, licensed ability to practice across state lines, and there is room for discussion here when we consider the need versus how the licensing can be implemented. I have received many requests to join online therapy corporations, and I'm assuming anyone with a license will receive one of these requests. Once we are licensed, that information becomes available to anyone who wishes to delve into it in any state. Anyone wishing to check on a license can go to their state licensing board and quickly retrieve someone's name and license number.

There is also a matter of dispute between healthcare professionals as to who is most qualified to provide these services. Currently, we have psychiatrists, psychologists, nurse practitioners, and several other types of individuals who may be certified by a group but not necessarily professionally licensed by their state. This brings up an additional concern for consumers, who must ensure that they are receiving services from a qualified and licensed individual.