Hey Siri! How’s My Mental Health
If you’re like me, you probably have a love-hate relationship with your “smart-devices” - jumping between "they collect too much data, are distracting, and waste so much time" to "but they are so convenient and provide so much information". Recently I discovered the sleep function on my AppleWatch and I now wear it every night to bed so I can track my sleep and make sure I’m doing it right. Is that a step too far? Or is this the future of health tracking - both physical and mental? A recent paper* thinks the answer is YES! However, there are concerns that need to be addressed to make this work.
Our smartphones provide instant communication and access to information from virtually anywhere. They can also continuously track and collect multiple data points at any given time, but can this data be transformed into actionable points for the diagnosis and treatment of health conditions and specifically mental health conditions. The ultimate aim would be to create a comprehensive and reliable “Electronic Mental Health Record” that would aid both the patient and the psychiatrist. However, in addition to the medical issues involved there are technical, legal, commercial and of course ethical concerns of using such technology.
The accuracy of currently available apps is questionable as the medical app market is not regulated and therefore, is not based on scientific data nor are they developed by physicians. The data collected can also be inaccurate, there is frequent over or underestimation and variability of measurement as the sensors in most commercial wearables are not medical grade. Barriers to entry are very low, and “clinical trials” are skipped as most apps just want to quickly go live at minimum cost.
And then there are the privacy issues… the current commercial model of tech companies is repackaging collected personal data into data products and subsequently reselling to prospective buyers. So, in effect data once collected can never be fully deleted. This leads to the classification of people, which goes beyond targeted ads and product sales but will have an impact on education, credit, employment, and healthcare with real-life consequences. Think about it - how many times have you really read the privacy documents before clicking “Agree”. Besides, healthcare systems do come under cyberattacks, and unfortunately, they do not have the money to spend on sophisticated IT systems like the financial sector.
Beyond the technology, there is the most important but often overlooked element - the user. Although it seems like everyone has a smartphone these days, not everyone has the same accessibility nor utilizes their smartphone’s full capability. Older populations and those with certain mental health conditions may not have the digital skills necessary and it is, therefore, essential to invest in raising digital skills on a population level to decrease inequalities.
It is also important to understand how disheartening it can be to constantly collect“disease” data about yourself. It’s one thing to track health data when you are healthy and another altogether when you are sick. The constant reminder is depressing, annoying, and a burden on general well-being which could lead to many seriously sick people abandoning the technology.
On the other hand, there is the risk of medicalizing “Normal States” which could lead to self-diagnosis and worse.. self-medication and treatment in people who don’t need it. It is also common for conditions such as anxiety and depression to become worse with excessive phone usage especially with compulsive dependence on App generated data and an addiction to social media.
So what kind of benefits are smart devices promising. Apps that provide breathing, meditation, and mindfulness prompts to promote wellbeing are already available and quite popular. Currently Apps are being developed that could monitor certain behaviors that are correlated with symptoms of depression and anxiety such as activity and social interaction levels. It can be even more sophisticated by providing a means to track whether patients are taking their medications. About 50% of patients do not take their medications as prescribed either because of forgetfulness or reluctance. Abilify is the first FDA-approved pill with a “Digital Injection Tracking System”. When ingested the pill sends a signal to a wearable patch, which then communicates to a mobile device the time the pill was taken along with other relevant data. Abilify is used to treat psychotic symptoms in schizophrenia, but the technology may be useful to track, in real-time, the medication adherence of other patients and alert health care providers when an intervention is needed.
The future is digital - better, smaller, and less intrusive wearables are being rolled out, providing each of us with a smart efficient personal assistant. However, we must ensure that health apps are developed with physicians and patients and that they are regulated by the appropriate health authorities before release.
So, do you think you will be using more health functions and apps on your smart devices? As for me, I have reached a point where I should change my emergency contact to “Apple” as they probably know more about me than anyone else.
* Link to paper: Smartphones in Mental Health: A Critical Review of Background Issues, Current Status and Future Concerns https://link.springer.com/article/10.1186/s40345-019-0164-x