Recent statistics show that 17% of the adult population in England are affected by depressive and/or anxiety disorders. The onset of more than 25% of depressive disorders and 75% of anxiety disorders occurs before the age of 21. As early intervention plays an important part in the long-term success of therapies, the ability to identify and manage these common mental health conditions in young people suggests a window of opportunity for improving long-term mental wellbeing.
As part of My Healthy Future, PHG Foundation are hosting stakeholder workshops to explore the role of evolving biomedical and digital technologies in improving the health of individuals in 20 years’ time. Participants are considering the challenges, opportunities and potential impacts on health systems and wider society that these technologies present. The second life-stage workshop focused on the future of adolescent health, with particular areas of interest in mental health, sexual health and the development of health behaviours. One of the major themes emerging from discussions was mental health among young people, and the use of digital interventions to support this.
Could digital tech help to identify mental health disorders?
The high ownership of smartphones, use of social media and digital literacy of young people suggest new ways by which to identify signs of mental health disorders in young people. For example, use of social media or the Internet for more than two hours per day is associated with psychological distress, depressive symptoms and low self-esteem in young people. Content posted, such as photos using Instagram filters to reduce brightness and colourful tones, and distinctive words or phrases may also suggest the onset of mental distress. On the other hand, there is growing awareness of the ways social media can contribute to mental health issues in adolescence and may perpetuate feelings of anxiety, depression, social exclusion and dissatisfaction with body image, in addition to providing a means for cyberbullying.
The associations between signs of mental health disorders and their contributory factors have always been complex (for example in relation to drug and alcohol use) and adding social media to the mix adds another layer of complexity in distinguishing between cause and effect.
Can digital tech help deliver mental health interventions?
The potential of digital technology to not only pick up the earliest indicators of mental health disorders, but to also deliver interventions was considered at our workshop.
It is estimated that only around 25% of children and young people with mental health disorders are able to access the help they need. Recognition that mental health services are struggling to meet demand has led to mental health gradually moving up the agendas of policy makers and health services. Responses on a national government level include £1.4bn of government funding for child and adolescent mental health services by 2020/21, and improvements to mental wellbeing education in schools, delivered as part of Personal, Social, Health and Economic Education (PSHE) programmes.
However, very few digital mental health tools are designed specifically for young people. Bearing in mind the importance of early intervention, this suggests a significant opportunity for improvement.
At the My Healthy Future workshop, we began the process of envisaging ways in which digital technologies may provide personalised advice or signpost individuals to mental healthcare services, including digitally enabled therapies. Of course, using digital technology to deliver mental health interventions is not that novel. Recent years have seen exponential growth in the development of mHealth apps, of which almost 5% specifically focus on mental health support and management, including tools for digital cognitive behavioural therapy (CBT), mood tracking and accessing peer support groups.
Department of Health and NHS England reports published in 2015-6 highlighted the potential of digital mental health tools to enable self-care and access to reliable information, and the NHS Children and Young People’s Improving Access to Psychological Therapies Programme is proactively seeking involvement of young people in digital development. However, very few are designed specifically for young people. Bearing in mind the importance of early intervention, this suggests a significant opportunity for improvement.
Is digital tech the solution?
The potential for digital health interventions is only expected to expand in the future given the developments in digital and data driven technologies and analytics. However, currently only a small minority of mHealth apps go through any approved evaluation process. The need to increase capacity for assessment will become more pressing as apps continue to be developed and made available to the public.
There are signs of progress – organisations such as NHS Digital, the National Institute for Health and Care Excellence (NICE) and Our Mobile Health can provide rigorous evaluation of mHealth apps, support to app developers to fulfil safety and clinical effectiveness criteria and are establishing designated libraries of trusted and evidence-based digital tools. With such reassurances, it is possible to envisage a future where mHealth apps are incorporated into routine healthcare, and where clinicians may prescribe or at least recommend digitally enabled therapies alongside other treatments for people with mental health disorders.
The human factor
Technology is developing at a rapid pace, but as well as the opportunities to support and improve mental health, the growing use of digital technologies may also negatively impact on mental wellbeing.
Participants reflected on the value of sympathetic and face-to-face interactions with trained healthcare professionals to get a complete picture of underlying factors and to get a handle on any vulnerability issues that may take more in-depth probing to identify. While some people may well value the anonymity that, for example, chatbots can provide, and be encouraged by their accessibility to seek help, overreliance on technology may contribute to a sense of social isolation.
Digital technologies alone cannot provide adequate intervention in all cases and, for some, may not be part of the solution at all. For example, their ubiquity should not be equated with accessibility. However, in the future, alongside other interventions, clinical assessment and supervision, they may increasingly assist in the early diagnosis and treatment of mental health disorders in young people, empower young people to self-care, and help to improve the long-term mental wellbeing of young people into adulthood.