• Becky Sarson

The Future of Mental Health Intervention?

Mental health and its impact on people is something that is particularly close to my heart, and an area which is still horrifically under-served and riddled with stigma.

No one gets ostracised from work or social groups for breaking their arm, but for someone who is going through mental health problems this is the harsh reality. In recent history more and more leaders of industry and high achievers are ‘coming out’ as having mental health issues and dealing with various disorders, but there is still so much that needs and should be done.

An index of 301 diseases found that mental health problems are one of the main causes of overall disease burden worldwide, accounting for 21.2% of years lived with disability. According to the 2013 Burden of Disease Study the dominant mental health problem is depression followed by anxiety, schizophrenia and bipolar disorder. Depressive disorders also contribute to the burden of suicide and heart disease on mortality and disability, having both a direct and indirect impact on people’s length and QoL.

According to the Office of National Statistics, in 2014 there was a total of 6,122 suicides in the UK in people aged 10 and older. This is 10.8 deaths per 100,000 population meaning that approximately one death every two hours is a suicide in the UK. People with a diagnosed mental health condition have been shown to be at a higher risk of attempting and contemplating suicide4 and more than 90% of suicides and attempted suicides have been found to be associated with a mental health issue.

In the UK in 2014 the leading cause of death for men under 40 and women aged 20-34 in England and Wales was suicide. This is a shocking statistic. If someone gets diagnosed with cancer they get expedited in to a system that supports them, treats them as intensively as is possible and fights to cure. Why is this not happening in mental health when it has been the biggest killer in the UK?

Identifying and Accepting there is problem

Nearly half (43.4%) of adults think that they have had a diagnosable mental health condition at some point in their life (35.2% of men and 51.2% of women) but only a fifth of men (19.5%) and a third of women (33.7%) have had any diagnoses confirmed by professionals.

The social stigma that still surrounds mental health means that for a person to come to terms with the fact that they may be struggling remains a tough one, even today. Mental Health is not something people feel able to openly discuss with friends, family or colleagues. Once the words have left their mouth, they can never come back. The fear is still that they will forever be judged and their actions forever under surveillance from then on.

I speak from experience here, being open about who you are is like coming out as gay 50 years ago. The harsh reality is people do treat you differently. Behaviour towards someone with mental health problems can be primitive, akin to that of apes or children – it’s ignorance at its worst. Of course, not everyone is on these extremes but it is despairingly common.

Luckily, more is being understood about mental health and greater numbers of people are speaking up, showing the world that they aren’t ‘lunatics’ or ‘crazies’ at all and don’t need to be treated with kid-gloves. They are high-functioning members of society who think and respond differently to the general public, and isn’t that actually a wonderful thing? This changing perception is giving people who do struggle with mental health issues more confidence to be who they are and be more open, but it will take time.

However, for those who may not be ready or even aware that they have an issue yet, their social media account may already know….

For years social media has been cited as a major contributor to mental health issues such as depression. People using social media accounts are portraying falsely positive lives whilst simultaneously aspiring to be as positive as their peers. Chasing lives that aren’t real.

However, social media, instead of contributing to people’s mental health decline, may now be helping to provide insights in to someone’s mental health through their use of various platforms. For example, a recent study in to the use of Instagram has revealed that there is a relationship with people’s interactions on this platform and predictive markers of depression.

“What if you were feeling depressed, but didn’t quite know it yet – would your depression still show up somehow in the photos you shared online? This possibility got us thinking: how might we combine what psychologists know about depression, with what data scientists know about analytics, to develop a quantifiable approach for evaluating mental health on Instagram? The results of our work suggest that early-warning signs of emerging mental health issues like depression can be observed in Instagram posts, even before any clinical diagnosis is made.”

Andrew Reece, 2017

This study could prove invaluable in helping people to address their mental health and try to begin to do something about it before it becomes a major depressive episode. If users are displaying online behaviours that are synonymous of someone who is becoming depressed, targeted messaging could be applied through integrated social media platforms to encourage users to seek professional help if they are displaying signs of mental health issues.

Getting help when there is a serious problem

When someone with a mental health issue is not well, it can be difficult for them to gain the perspective required to realise they are not well.

It’s not like having a cold where the symptoms are obvious. Often symptoms of decline creep up. People spend time ignoring, dismissing or normalising them and before that person is aware of it they are in danger, especially if they live alone, which many people with mental health issues do.

During this time people are interacting with the world around them differently and in a more extreme manner. They may be overcompensating: ‘hey look, I’m doing a million amazing things’ or becoming more reclusive and non-responsive. This is something that technology, because it is such a massive part of our lives, could recognise and intervene with before that person has even acknowledged that their interactions have changed.

Technology already knows more about us than we realise. I heard a statistic earlier in the week that Facebook knows you better than your spouse after only 300 likes! More than that though, as humans we are creatures of habit. We demonstrate the same behaviour patterns over and over, and this is true not only of our physical day to day behaviours but also our online worlds and use of technology.

Artificial Intelligence (AI) affords us the capability of assessing these patterns over time using historical usage data and being able to see what the individuals ‘normal’ is. We can then use this information to learn when people with mental health issues behaviours are changing and they might be at risk of a relapse or depressive episode.

Overlay this data with physical tracking data collected through everyday wearables such as sleep patterns, heart rate and activity levels (to name a few!), that changes in (alongside other symptoms) could be used as markers for a depressive episode. Using all this data we can begin to build up a really good picture of how that person might be coping and whether they may need interventional help from their care team, family or friends.

But what if it is 3am and that person is alone and in serious trouble?

You have been exercising more than usual, but your sleep over the last few nights has been erratic. Your wearable device sees that your heart rate (HR) seems got be elevated to 152 BPM when your resting HR is usually between 47-52 BPM, it’s 4:20am and your alarm isn’t set for another 2 and a half hours. It’s another panic attack thats woken you up, but you’re alone so there is no one to help with your breathing and rationalise the impending sense of dread….

What if we could feed the data being collected on the individual in to a ‘home assistant’ such as Alexa? In the example used above we could in theory, be able to provide the person having a panic attack with interim therapy using artificial emotional intelligence (AEI), provide them with some calming exercises and mindfulness relaxation to control their breathing, until they are able to get to their healthcare professional and seek help in the morning.

AI systems are becoming increasingly more powerful and, when connected to other devices and sensors, I believe that we can use them to not only identify when there might be a problem, but use them to intervene. AEI gives us the opportunity to intervene with real empathy and help to begin to engage some of the most isolated populations when they are at their most vulnerable and potentially prevent another suicide.

1. Vos, T., Barber, RM., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., …Murray, CJ.. (2013). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease study. The Lancet, 386(9995), 743–800.

2. Mental Health Foundation, (2016) Retrieved from: https://www.mentalhealth.org.uk/publications/fundamental-facts-about-mental-health-2016 [Accessed 25/01/18]

3. Ferrari, A.J., Charlson, F.J., Norman, R.E., Patten, S.B., Freedman, G., Murray, C.J.L., … & Whiteford, H.A. (2013). Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease study 2010. PLOS Medicine, 10(11).

4. Hawton, K., Houston, K., Haw, C., Townsend, E., & Harriss, L. (2003). Comorbidity of Axis I and Axis II Disorders in Patients Who Attempted Suicide. The American Journal of Psychiatry, 160(8), 1494–1500.

5. Conwell, Y., Duberstein, P.R., Cox, C., Herrmann, J.H., Forbes, N.T., & Caine, E.D. (1996). Relationships of age and axis I diagnoses in victims of completed suicide: A psychological autopsy study. The American Journal of Psychiatry, 153(8), 1001–1008.

6. ONS. (2016). Suicides in the United Kingdom: 2014 Registrations. Retrieved from ons. gov.uk/peoplepopulationandcommunity/ birthsdeathsandmarriages/deaths/bulletins/ suicidesintheunitedkingdom/2014registrations [Accessed 25/01/18].

7. Reece, A and Danforth C, (2017). Instagram photos reveal predictive markers of depression. EPJ Data Science 6:21

8. Reece, A, (2017). What do your instagram photos reveal about your mental health? Retrieved: http://www.uvm.edu/storylab/2017/08/08/what-do-your-instagram-photos-reveal-about-your-mental-health/ [Accessed 25/01/18].

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