Mental illness is common and disabling but the evidence is that fewer than half of people seek any treatment and few receive any help from specialized mental health professionals. In Canada, there are long waiting lists to see psychological therapists face to face despite the importance of non-drug therapies. One way to address this problem is to use computerized e-therapies which deliver structured mental health treatment via a computer. Dr. Simon Hatcher, Psychiatrist at The Royal's Community Mental Health Program and Vice Chair of Research for the Department of Psychiatry at the University of Ottawa, lead a discussion about the role of technology in mental health treatment. Highlights include: the effectiveness of online mental health treatments and opportunities for innovation and policy change in field of mental health.

1. Using Technology for
Mental Health
Treatments
Presented by: Dr. Simon Hatcher
March 24th, 2016

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Are computerized therapies the way
of the future?

3. 3

4.  First healthcare revolution
1850 to 1960 – antibiotics,
advances in physiology and
anatomy
 Second healthcare revolution
1960 to 2000 – stents,
transplants, randomized
controlled trials
4
Historical Perspective

5. □ Driven by:
□ Citizens;
□ Knowledge;
□ Personal computing
focused on patients.
□ Personalised medicine -
usually genes but also
applies to habits.
5
The Third Healthcare Revolution

6. Current Healthcare Landscape
Problems in Healthcare
Organizations
Harm
Waste
Variation
Inequity
Failure to prevent
Challenges to be
Addressed
Rising demand
Increased need
Financial restraints
Carbon restraints
6

7. 1. First generation
□ “Books On-Line”
2. Second generation
□ Some on-line interaction
□ Complete questionnaires
and answer quizzes
□ Learning by gaming
(SPARX)
3. Third generation
□ Integration with
mobile phones, email,
and/or smart devices
4. Fourth generation
□ Smart environments
and “mobile
therapists”
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E-Therapies

8.  No waiting lists.
 No stigma.
 Can be tailored for specific
groups.
 Addresses work force
problems.
 Cost effective?
 Better?
 New treatments?
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Use of e-Therapies in Mental Health
Treatment

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11. Trial in New Zealand
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63 participants
Most completed only two or three sessions
Fewer appointments 3 vs 4 with mental health services

12. Canadian Trial of The Journal
• Recruited 84 people
• Mean baseline PHQ-9 15
• Much better adherence to program 2/3
completing six weeks
• Results due later this year
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Canadian Trial of The Journal
“The Journal is my mirror
- in my 56 years this is
the first time I’m seeing
myself inside and out."

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Canadian Trial of The Journal
“I am grateful to be a part of the e-Therapy
Program… With the guidance and support from my
husband, you and the team, all my family members are
seeing a huge change in me…I’m putting things behind
me and moving forward. I’m looking at the positive. I
know I’m not alone in this world. I’m so grateful to be
alive, and so grateful to be working with you.”

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http://www.ehub.anu.edu.au/welcome.php

20. 23

21. 1) Samples Used: “community” versus clinical are often self
selected.
2) Control Group Used: waiting list or treatment as usual.
3) High Drop Out Rates: 60-80% but this is comparable to
other psychotherapies.
4) Little information available about acceptability or
feasibility.
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Limitations of Previous
Randomized Controlled Trials (RCTs)

22. For people with persistent subthreshold depressive
symptoms or mild to moderate depression, consider
offering one or more of the following interventions,
guided by the person's preference:
• individual guided self-help based on the principles of
cognitive behavioural therapy (CBT)
• computerised cognitive behavioural therapy (CCBT)
• a structured group physical activity programme.
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Effectiveness of e-Therapies

23. • include an explanation of the CBT model,
encourage tasks between sessions, and use
thought-challenging and active monitoring of
behaviour, thought patterns and outcomes
• be supported by a trained practitioner, who
typically provides limited facilitation of the
programme and reviews progress and outcome
• typically take place over 9 to 12 weeks, including
follow-up.
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Effectiveness of e-Therapies

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Virtual Mental Health Clinic

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Virtual Mental Health Clinic

26. □ Not limited to replicating face to face therapies.
□ Scope for innovation - gaming, use of social marketing.
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Opportunities for Innovation

27. □ Issues with evidence,
content and privacy.
□ Use of ACHESS with male
Veterans in the USA to
treat substance abuse.
□ Development of a
smartphone application
to supplement face to
face therapy after self-
harm.
□ RCT to be launched by
end of 2016.
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The Use of Smartphone Technology

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29. □ Useful in treating phobias
and anxiety disorders.
□ In the future, possibility of
reliving the past.
□ Other uses include:
Conversation Skills Training
Assertiveness Skills Training
Emotion Expression Skills
Training
35
Virtual Reality

30. Google Glasses:
provide “reality
based feedback”.
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Wearable Computing

31. □ Prompts to take medication
□ Therapeutic robot animals
□ Mind exercises and communication
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Robots
Paro Robot

32. □ Use of Brain Stimulation
□ Memory Chips
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Brain Implants

33. • Netflix
• Real time patient feedback
• The power of groups
• Social media surveillance
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Big Data and Social Media

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35. ☐ Reinforce inequalities:
☐ Issues of access
☐ Language
☐ Limited evidence of effectiveness
☐ Ethics of monitoring
☐ Rapidly outdated/costs
☐ Privacy and risk issues
☐ Seductive
☐ Regulation
□ No mechanism for rolling out online
treatments including:
□ Budgetary decisions
□ Integration into existing clinical
pathways
□ Who would “manage” it
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Problems with New Technologies

36. 42

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38. □ Person centred
□ Scalability
□ Quality assurance framework
□ Research
□ Knowledge translation and
exchange
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Opportunities for Policy Change

39. IIn
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□ Integration with existing health and
technology policy
□ Integration with existing health
services
□ Sustainability
□ Privacy and security
Opportunities for Policy Change (2)

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Questions or Comments?
Dr. Simon Hatcher
Email: simon.hatcher@theroyal.ca
Twitter: @shatchernz
Blog: https://shatchersite.wordpress.com/