The Psychiatry of the Future

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By Dr. Simon Hatcher

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The Psychiatry of the Future

  1. 1. The Psychiatry of the Future: computerized therapy, virtual reality, brain implants and other fantasies
  2. 2. Are computerized-therapies the way of the future?
  3. 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. 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. 5. Third Healthcare Revolution • Driven by citizens, knowledge, personal computing focused on patients • Personalised medicine (usually genes but also applies to habits)
  6. 6. The future
  7. 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. 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• • • • • • Reinforce inequalities – access and language Limited evidence of effectiveness Ethics of monitoring Rapidly outdated Privacy and risk issues Seductive (!)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. 9. Do they work? • Recommended by NICE for mild to moderate depression and anxiety • But evidence not strong and in non-clinical populations.
  10. 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. 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. 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. 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. 14. Opportunity for innovation • Not limited to replicating face to face therapies • Scope for innovation – gaming, use of social marketing
  15. 15. Virtual reality • Mainly phobias and anxiety • But in future possibility of reliving the past
  16. 16. Augmented reality • Google glasses – “reality based feedback”
  17. 17. Robots
  18. 18. Brain implants • Brain stimulation • Memory chips
  19. 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. 20. Contacts • shatcher@uottawa.ca (email) • @shatchernz (twitter) • http://uottawapsychiatry.blogspot.ca/ (blog)

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