Winter is coming: moral duty in digital mental health #mhqt

The following is the text of a short talk given by Mark Brown as part of the panel discussion ‘Digital Mental Health: Waiting for the Great Leap Forward‘ which took place at The institute of Education, London as part of a series organised by the UCL Division of Psychiatry, The Lancet Psychiatry and the National Elf Service.

We are in the middle of the biggest roll back of public spending in generations.  In the form of brexit we’re embarking on the biggest experiment in leaping into an economic and geopolitical unknown that our country has seen in at least a lifetime.

In mental health we can assume that the world we see around us will always look much the same as it does.  That institutions like this one we’re sitting in will always be here.  That there will always be an NHS.  Always be social care. Always be human rights.  Always be helplines.  Always be homes and jobs and opportunities.  I think right now we can assume no such thing.

This might sound alarmist, but in mental health we have always been too complacent, too cautious and too ready to accept that things will turn out all right contrary to what we know and we see every day. Life for people with severe and enduring mental health difficulties has been getting worse.

That is what makes our job in mental health all the more important and desperate.  Right now digital technology is one of the areas of exploration where the promise exceeds the probability in mental health.  In much of the rest of the adult mental health world our possibilities are plateauing, either because we have run to the end of possible ways to wrestle anything better outcomes from a discovery or a practice; or because public and political will to provide the resources to fully use something to change people’s lives has flatlined.  There is nothing traditional on the horizon that will save us from failing people with mental health difficulties in worse and more painful ways in future than we are today.

Digital technologies are one of the areas where there are new frontiers to be explored, potentially in ways that avoid existing strictures that prevent more traditional means of helping people from doing more to change people’s lives.  Digital technology creates hybrids: it takes what we know in one area and finds new ways of doing it.  As such, digital technology is our best bet for better mental health because we already know a lot about mental health.  And other people know a lot about tech and also make a lot of money out of getting it right.  So, we’re halfway there.  The direction of travel is that there will be more breakthroughs and research in digital technology each year, which means if we carve out a space for mental health in that we will reap the benefits of a direction of innovation that is already unfolding.

We have the grounding, in theory, to shape technology into something transformative and caring and sustaining for mental health.  We need to get out there and get messy and get building and talking and gossiping and building and breaking in the understanding that a lot of things won’t work on the path to what does.

If you do not let yourself travel close to the edge of your domain of interest you will never see the domains that neighbour it. Safe in the capital city of mental health, where the streets stay familiar and the sound of change hasn’t brought angry voices to the streets and their barricades, you will be able to comfortably assume that nothing will ever change. you will never see the winter is coming.  And it is coming.

In large parts of the world, though not everywhere, we are in the age of ubiquitous computing.  People carry with them the most amazing, powerful tiny computers in the form of smartphones.  We tend, if we are not careful, to see these tiny computers just a vehicles for information or apps but they are much more than that.  They can process information. They can collect data.  They can receive and they can broadcast.  They can overlay one reality with another.  And they can take phone calls, sometimes.  People choose to carry these amazing devices because they love them and because these devices both make sense of their world and make sense in their world.

To play at William Gibson quotes again, ‘the street finds its own uses for technology’.  People are already using digital technology in amazing, nuanced, inventive and shocking ways and we know next to nothing about that in mental health. We do not know how people who experience mental health difficulties and distress actually use technology now.  We occasionally recruit thirty people and ask them if facebook makes them sad.  We occasionally prod some people into a trial of a digital technology that we think they should like. We keep asking the arse-about-face question ‘what is digital technology doing to our mental health?’ when we could be asking ‘what could digital technology be doing FOR our mental health?’

A colleague said to me that when you are developing technology, or indeed anything, in health and social care you are never building on a green field site.  We’re always building on reclaimed brownfield land.  There are always neighbours, always NIMBYs, always hidden deposits of gas and uncharted subterranean catacombs.  Making something new is all barriers.  It needs to be all barriers if you don’t want to kill someone. Or even if you do I suppose, thinking about it.  Regulation and safeguarding is important as the way that innovation is prevented from causing harm.  We need to use that as a positive force, not a negative one.

We have two tasks, should we chose to accept them.  The first is to immerse ourselves in the possibilities of technology, to look at how we make technology happen, how we can marry it with mental health knowledge and mental health need.  The second mission is to actually understand how people use technology now and how they might use it in future and what that means for how we need to make things that work for them.  Right technology, wrong user experience is the same as wrong technology.  Understand people’s interactions with digital technology and you’ll understand how to put a life changing technology in a form that will work for them, not against them.

The TL;DR here is: Things are looking shit in general, and things are looking really shit for people with mental health difficulties, so we have a moral duty to not make sure digital technology isn’t shit too.

Mark Brown is development director of Social Spider CIC. He is @markoneinfour on twitter.

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One Response to Winter is coming: moral duty in digital mental health #mhqt

  1. Steve Deckett says:

    As a psychiatric nurse of 40 years, I am implacably opposed to this. I left the health service because I spent my time nursing machines which insisted I put in data – most of which was simplistic garbage. I never had time to meet my patients even though their needs were great. Thinking that data of any kind can solve mental health issues is absurd, with the only possible exception of research. Governments will love the claim that they can care for a person using data interfaces, as they cost so little. They will massage the data so it sounds plausible, but people need people. They need people that can listen and have time and resources to intervene in the real world issues they face. Mental Health in the UK is such a failure because the carers are now nursing the government and it’s incessant demands for more data – this is not a quip, its every day reality for care coordinators and others that face front line care. When I started in 1974, we spent 99% of our time with our patients, this has all gone, they don’t matter anymore to the system except as data sources. Asking questions in order to complete forms is not the same as listening, though it may be disguised this way.

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