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The Psychiatry of the Future

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By Dr. Simon Hatcher

By Dr. Simon Hatcher

Published in: Health & Medicine
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  • 1. The Psychiatry of the Future: computerized therapy, virtual reality, brain implants and other fantasies
  • 2. Are computerized-therapies the way of the future?
  • 3. The past • First healthcare revolution 1850 to 1960 – antibiotics, advances in physiology and anatomy • Second healthcare revolution 1960 to 2000 – stents, transplants, randomized controlled trials
  • 4. The present 2013 Problems in healthcare organisations Harm Waste Variation Inequity Failure to prevent Challenges Rising demand Increased need Financial restraints Carbon restraints
  • 5. Third Healthcare Revolution • Driven by citizens, knowledge, personal computing focused on patients • Personalised medicine (usually genes but also applies to habits)
  • 6. The future
  • 7. Why e-therapies • • • • • • • Sooner, more convenient, no waiting lists No stigma Can be tailored for specific groups Addresses work force problems Cost effective? Better? New treatments?
  • 8. Problems with new technologies • • • • • • Reinforce inequalities – access and language Limited evidence of effectiveness Ethics of monitoring Rapidly outdated Privacy and risk issues Seductive (!)
  • 9. Do they work? • Recommended by NICE for mild to moderate depression and anxiety • But evidence not strong and in non-clinical populations.
  • 10. Issues with RCT’s • Sample – “community” versus clinical often self selected • Control - waiting list or treatment as usual • Drop out rates high – 25-40% but comparable to other psychotherapies • Little information about acceptability or feasibility
  • 11. E-therapies 1. First generation – “books on-line” 2. Second generation – some on-line interaction – fill in questionnaires, answer quizzes, learning by gaming (SPARX) 3. Third generation – integration with mobile phones/email/smart devices 4. Fourth generation – smart environments and “mobile therapist”
  • 12. National Depression Initiative • Reduce stigma • Educate GP’s – guidelines, training • John Kirwan – Depression.org.nz – Social marketing – E-therapy for mild to moderate depression – Telephone help line
  • 13. Journal Lesson Activity #1 13,020 #2 2,350 #3 3,700 #6 650 1,700 1,100 1,200 June 2010 to July 2011 700,000 visitors 20, 000 registered with The Journal 13,020 active users
  • 14. Opportunity for innovation • Not limited to replicating face to face therapies • Scope for innovation – gaming, use of social marketing
  • 15. Virtual reality • Mainly phobias and anxiety • But in future possibility of reliving the past
  • 16. Augmented reality • Google glasses – “reality based feedback”
  • 17. Robots
  • 18. Brain implants • Brain stimulation • Memory chips
  • 19. Policy? • Current IT policy focuses on infrastructure • No mechanism for rolling out – budget line, integration into existing clinical pathways, who would “manage” it; evaluation • Integration with workforce planning • Need to plan for innovation and obsolescence • Confidentiality and risk (need to protect from legislation) • Professional and provincial boundaries
  • 20. Contacts • shatcher@uottawa.ca (email) • @shatchernz (twitter) • http://uottawapsychiatry.blogspot.ca/ (blog)

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