m-Health Squared: The future of global mental healthcare? by Conor Farrington, University of Cambridge
A lot of science fiction seems pretty far-fetched; it’s hard to imagine flying to other galaxies at warp speed any time soon. But some science fiction becomes science fact far more quickly than we expect – think of the Star Trek ‘tricorder’, a hand-held medical device with such impressive capacities that you almost wonder what Dr McCoy is there for, apart from swapping one-liners with Captain Kirk.
The Star Trek tricorder is from the 23rd century, but recent advances in medicine and technology mean that a 21st century tricorder is by no means a fantasy (as evidenced by the $10m Qualcomm TricorderXPRIZE launched in 2012). Every week, almost every day, new medical devices are revealed, often in wearable or ingestible form – like Google contact lenses that measure diabetics’ blood glucose levels and smart medication that tells doctors when patients have taken their pills (or not). Intelligent scalpels identify malignant tissue in real-time, smartphones provide medical imaging and biometric data, and even ‘dumbphones’ can help track the spread of disease in poorer countries. Science fiction is becoming science fact.
However, despite the impressive progress to date, we can’t yet claim that technology is a panacea for all ills. Innovative healthcare solutions, technological and otherwise, always face a range of significant barriers before they make their way into everyday care – barriers that can range from stiff regulatory and legislative hurdles to healthcare professionals with vested interests in the status quo. The cumulative effect of these barriers slows down the pace of change and limits the impact of technology on healthcare. Moreover, even when new interventions do get through to patients, there is always a strong possibility that systematic differences in target populations – such as ‘digital divides’ between younger and older patients – will lead to uneven uptake and outcomes.
More fundamentally still, it’s also the case that some areas of health and illness – e.g. physical disorders – have received more technological attention than others, such as mental disorders. This is unsurprising partly because it reflects wider trends: clinicians and policymakers are renowned for prioritising physical health over mental health, while at the societal level widely-shared stigmas about mental health have proved difficult to overcome. But there is also a tangibility about physical disorders (and their resolution) that make them a more obvious target for innovation. By contrast, mental disorders are more fluid, more complex, and harder to ‘cure’ in a definitive manner.
This doesn’t mean that nobody is working on technological solutions to mental disorders or that such solutions are ineffective. In a recent paper published in Globalization and Health, my colleagues and I discuss the emerging field of mobile health interventions in mental health – a field we term mH2, or mHealth squared (symbolising the synergy of the two ‘m’ healths – mobile and mental). We discuss mH2 interventions ranging from the Mobile Mood Diary (involving patient-reported measures of energy, mood, and sleep levels) to the Mobilyze! system utilising 38 smartphone sensor values to predict users’ mood, emotion, activity and cognitive state in unipolar depression. However, while many emerging mH2 interventions show great promise, they exhibit a number of features – short-term project lifespans, small numbers of patients, and a focus on single rather than multiple mental disorders –that have, to date, limited their impact and influence in everyday mental healthcare.
In response, we argue for the need to develop an integrated mH2platform that would meet a range of criteria, including: integrated diagnostic, monitoring, therapeutic and educational capacities, targeting the full range of mental disorders; cross-context and cross-cultural adaptability, and interoperability with existing healthcare systems; the capacity to draw upon the full range of mobile capacities from SMS to voice-calls to smartphone sensors; and the capacity to enable a range of wider capabilities including social prescribing, online resources, and m- and e-learning about mental health. If co-designed with stakeholders across clinical, policy and public communities in a range of settings, and if rigorously tested at all stages of development and implementation, such a system could revolutionise mental healthcare by enabling remote, private, and personalised care delivery through a range of mobile technologies.
Crucially, we don’t see this platform as limited to Western contexts. In fact, key features of mobile phone usage and mental healthcare across the globe mean that the platform would almost certainly have a more dramatic impact in lower-income and lower-middle income countries. As data presented in our paper shows, poorer countries bear a high proportion of the global mental health burden with vastly smaller mental healthcare budgets and workforces. At the same time, though, poorer countries also exhibit the fastest growth in mobile subscriptions (46.29% growth from 2008-2012 vs 10.15% in developed regions), often skipping Western telecommunications development trajectories to embrace a ‘mobile first’ approach. The conjunction in poorer countries of high mental illness burdens and low levels of service provision on the one hand and relatively high levels of mobile coverage on the other highlight the potential to address the former via the latter, thus engaging with one of the most neglected – but also one of the most urgent – challenges in global health.
The main challenges in mH2 are not so much about invention as integration: adapting existing face-to-face interventions for a range of mental disorders and bringing them together in one mobile platform– a mental health tricorder – capable of implementation in a range of contexts worldwide. The resulting platform may not be as glamorous as Google contact lenses, but the likely impact on global health will be nothing short of spectacular.
About The Author
Conor Farrington is a Research Associate at the University of Cambridge Biomedical Research Centre (BRC). His research draws on philosophy and sociology to explore new medical technologies in a range of medical fields including global mental health, diabetes, and hypertension.
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