Lincoln (Nebraska), 1957. A harsh winter was approaching, with heavy snowfall, and Dr. Reba Benschoter, a mental health counselor, did not know how she was going to clarify the doubts of the doctors at the Norfolk hospital, located about two hours away. car from home. He solved it using the new technique of videoconferencing, through closed circuit television.
In those years the telephone was also used to support people with suicidal ideas. So it can be said that the use of technologies in this area of health has a long history.
From the first chatbot to self-guided treatments
Later, in 1966, the German-American scientist Joseph Weisembaum developed ELIZA, one of the first chatbots (computer programs capable of maintaining a conversation). ELIZA could summarize the question and answer the interlocutor. This type of response was very similar to that proposed by Carl Rogers (1902-1987), pioneer of humanistic psychology and known for developing so-called client-centered therapy.
Another important advance took place in 1972, when psychological tests were computerized. That is, more than 50 years ago we already had technological tools in the field of mental health.
Later, in the 90s of the last century, some studies began to reflect the satisfaction of mental health patients with telecare. But professionals felt uncomfortable and clumsy using these technologies.
Self-guided treatments were also developed at that time. Thanks to them, the person can conduct an intervention themselves to manage their anxiety or stimulate their cognitive abilities, as if using a self-help book. The novelty was that it was done with a computer. And more importantly: these treatments were not only satisfactory, but were beginning to demonstrate their effectiveness.
…And the pandemic arrived
Since the turn of the century, technological developments have advanced rapidly, but mental telehealth has adopted them slowly and discreetly. Not everyone participates in conferences and publications dedicated to the subject, and those who undertake this type of research are criticized for turning towards technology. A similar reaction occurred when the industrial loom was invented in the early 19th century.
Until, in December 2019, the first cases of a strange infection caused by a coronavirus were recorded in Wuhan (China).
When the Covid pandemic arrived, the use of telemental health was negligible in most countries. Only those who, due to their large area and low population density, had developed telemedicine models were saved.
Literally from one day to the next, everything that was done face to face had to be carried out through technology and remotely. No one was prepared, even though Reba Benschoter and so many others had pointed out for decades that the technologies were an opportunity.
During the pandemic, around 90% of mental health work was carried out using technologies and without face-to-face contact. Videoconferencing platforms had to adapt to the necessary confidentiality and encryption standards. But the means that was most used was the telephone, just as it was done more than 60 years ago to prevent suicide.
Currently, the regular use of technologies to provide mental health services is only slightly greater than in 2019. The pandemic forced us to distance ourselves to take care of our mental health and, once overcome, we learned little.
Applications by optional prescription
Are technologies useful in mental health? The answer is short and clear: yes. For example, studies indicate that technologically mediated interventions have similar effects to those carried out face-to-face in moderate anxiety and depression disorders. Countries such as Germany, England or Brazil have developed standards so that applications can be used as medicines. To explain it better, there are countries where you can prescribe a app.
Technologies are useful both for evaluation and for administrative tasks and providing treatments. For example, it is possible to assess the level of depression using a questionnaire on-line which gives an instant result. This result can be recorded in the electronic medical record, facilitating the coordination and decision-making of professionals.
Cognitive-behavioral treatment through videoconferencing has been shown to be effective in the treatment of depression. There are even studies that have shown positive effects on psychosis and support for caregivers.
Much research also indicates that virtual reality works in the treatment of phobias and post-traumatic stress. And recently, pilot work demonstrated that an intervention with a chatbot based on artificial intelligence was useful to reduce symptoms of depression in the short term.
All this, without delving into the possibilities of instantaneous ecological assessment (for example, through a mood questionnaire that is answered every morning and every night using the mobile phone); the usefulness of digital phenotyping (representation of people’s characteristics through the data collected by the mobile phone, such as steps, sleep routines and device use); the support that devices can provide wearables (wearables) to improve the autonomy of a person with brain damage, or the positive effects of social robots on dementia.
In summary, technology-based interventions have proven to be effective in supporting mental health treatments. But its use is low and its implementation is testimonial. The history of technologies applied to this area is full of pilot studies with positive results, but few are put into practice. Most successful developments become obsolete or abandoned within five years.
The law of the jungle
So, are the advantages of new technologies in mental health being taken advantage of? Today, the answer is stark, simple and painful: no.
Despite the fact that these advances are here to stay, that we use them regularly in our daily lives and that there is evidence of their effectiveness, there are no implementation or training policies to take advantage of them. Today, the use of technologies in mental health is governed by the law of the jungle.
Any professional accredited to offer face-to-face services can provide care via videoconference without the slightest prior experience. Universities teach content on telemental health in their subjects in a very limited and insignificant way. Only private healthcare has seen and taken advantage of these care models, but it does not have trained professionals.
And even worse. Since there are no professionals prepared to take advantage of these advances, it is not well known how to handle the problems and changes that come with their use. Thus, rather than enjoying the technological advantages, we are only suffering its negative consequences.
To take advantage of health technologies, the care model must change, which requires a change in strategy. This requires the will of the administration, new laws, defined policies and trained personnel. At the moment we don’t have anything like that. There are only many Reba Benschoters who continue to demonstrate that we are wasting the opportunities that mental health technologies give us.