Let’s face it. There are some big problems with the way we do mental health right now, and no, telehealth hasn’t solved everything. I’m going to list them off because there are that many.
I’m going to be using Australia as my data case study here, firstly because it’s where I live and work so I can comment personally and secondly because Australia is really a best-case, case-study.
We have 95 psychologists for every 100k people, everywhere else around the world that statistic gets worse, in the US for example, where most (non-US) people think it’s almost 1:1, the rates actually drop to 33 psychologists per 100,000.
We also have some of the most highly trained and updated psychologists with mandated professional development, annually.
- Around one in five Australians have a mental health condition in any given year (pre-pandemic figures, this is likely to be worse now but so far we have no updated figures), around 45 per cent of us will have one in our lifetimes
- As bad as this is, it is almost certainly an under-estimate as it excludes people who are homeless and those in aged care. It also excludes those who are just under the diagnostic criteria but would still have severe effects, and those who do not wish to disclose
- About 54 per cent of those in point 1 above, don’t ever access treatment
- If you live in a rural area you are three times less likely to access treatment, if you live in a remote area it is 10 times less likely
- Even if you get a mental health care plan (the government referral system in Australia, which reduces the cost of access to a psychologist), it’s hard to use it, in fact one in 13 plans are never used
- Wait lists are blowing out, with reports of “months” for psychologists in private practice and six to nine months for emergency help for severe mental health cases for children and adolescents (vii)
- Let’s say you get in, you still need to find a psychologist that you can build rapport with. Research with both men and women indicate a 25 per cent drop out rate overall. In one study on men in therapy in Australia, the drop out rate was at 45 per cent. Thirty per cent dropped out after the first session, and the main reason was a lack of connection with the therapist i.e. rapport
- Now let’s say you manage to be one of the lucky ones who find a psychologist you can connect to, most people present with a K10 or DASS21 questionnaire filled out with their doctor beforehand, and then it’s up to the psychologist and you the client, to work out what is happening for you. These are good questionnaires, but they are general and there’s not a lot of data there.
- Even if your psychologist is great at diagnosis, they are very dependent on the information you provide them from your memory. So do you have a good memory? Would you be comfortable putting your health in its’ proverbial hands? Or your wallet, as your therapy will likely be extended while the pair of you work it out.
- Your psychologist is also human and can tire, so though your psychologist is no doubt brilliant, if they have not slept well themselves, or if you are their last client in the day, their brain may not be as perceptive as if you were the first, impacting the questions they ask and the information you provide, and the diagnosis you get.
(I will stop here but I could also add … issues with hit and miss medications, medications linked to the worst outcomes (i.e. suicide) for reasons that we don’t yet understand, and the development of an expert cohort of psychologists taking almost a decade, and student to teacher ratios in university degrees that mean there is an inherent limit to the number we can create without massive quality control issues and costs).
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Most of these problems were certainly understandable in a time before the smartphone but as Barron pointed out in recently Time2030 (ix) in relation to psychiatry, it is time we started modernising mental health.
Your smartphone already logs your behaviour in many ways. It records your expressions when you take a selfie or make a story or stream, it also records your thoughts and moods through social media, IM and email. These are data points that would certainly improve the accuracy of your diagnosis if it were used.
However … would you feel comfortable handing over your social media to a psychologist? Or your Instagram selfies? Most people would say no. It’s also fundamentally biased. Few people ‘gram their worst moments. Most of us preference the good stuff in our lives, and our good hair days, for the likes.
So, we can’t just hand over any old behavioural data, however accurately collected.
There are great solutions to be had in all this though.
Solutions that give psychologists the right information for an accurate diagnosis, every time, that connect you to mental health services in new ways that are more accessible, and get help to those who feel uncomfortable talking to a person, that give more access to those who need a diagnosis but don’t yet have it, and who use big data to improve this in ways that could show us the errors in any psychiatric diagnostic manual.
There is a lot of hope in how big data can create mental health services that help everyone so much more, not least of all the hard working psychologists.
Finally, the need to improve is great, with increasing suicide rates overall and, importantly, some studies telling us that the services have not yet quite hit the mark.
One study found that up to 60 per cent of the men who die by suicide in Australia have sought help in the year prior. So, clearly, the services neither helped them sufficiently, nor demonstrated to them that mental health services are the place to go for help.
Lots to do, but we are starting to solve it for children first, at Gheorg.
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