How our 'digital footprints' are changing mental healthcare

By Laura Lovett
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Every patient experiences mental illness differently, but as technology becomes more ingrained in people’s lives, it’s easier to track behavior and how that correlates to mental health, John Torous, MD, co-director of digital psychiatry at Beth Israel Deaconess Medical Center said today at Mad*Pow's Health Experience Design (HXD) Conference in Cambridge, Massachusetts.

“In some ways the first application of technology is going to be to redefine what are those mental illnesses,” Torous said. “Now we can measure with self-report surveys, can measure behavior on the phone, with GPS how active you are, with calls and texts messages how social you are. Can we redefine what the lived experience of mental illness is and then can we match it up to all this biological data? …In someways, we are looking to treat mental illness but are we going to have to redefine mental illnesses with these technologies.”

Sometimes patients are even more honest with an app on their phone than they are with their provider. For example, Torous referenced a study he was involved in a few years ago where patients were asked nine questions over 30 days. In that survey, researchers found that patients were reporting more suicidal thoughts to the app than to their provider. 

"No one wants data. People want insights and action."

John Torous, MD, Beth Israel Deaconess Medical Center

This data raised a lot of questions about the patient-provider relationship and technology. There’s still no answer to these questions, he said. But one thing is clear, phones can provide clinicians and with a lot of data. 

“You can almost get a digital fingerprint based on the raw data that the smartphone is producing,” Touros said. 

But that data can be clunky and difficult to interpret. That’s why Torous said its important to think about adding new staff to deal with these questions. 

“No one wants data. People want insights and action,” Torous said. “But how do you deliver insights and action? The apps can gather all this interesting information and can run algorithms to predict some simple stuff but you probably need a new person in the loop. We call them a digital health navigator or digital clinical staff—someone who is going to look at that dashboard and [act as a] kind of liaison with the mental healthcare [team.]”

Torous noted that it is important not to let the technology interfere with the patient and clinical relationship. 

On the patient side, he said many people are interested in tracking their health. For example, one of his patients with schizophrenia uses technology to track if his medication is working by monitoring the drugs he is taking in relation to how many voices he is hearing everyday. 

But in the long run, this technology is still new and could go beyond just identifying mental health conditions.

“Relapse is only the first part of it. But can you imagine the world where for mental health treatment we can report cognition from these [phones] and physical activity and we know what environment you are in,” Touros said. “If we have all that information we can use and have a new way to think about care, wellness, and treatment so we’ve developed our own app called LAMP.”

Torous and his team will be starting a small digital clinic at Beth Israel this fall and LAMP will be a part of that. 

As the technology pushes forward, Torous reminded the audience that it's best to make sure the patient is still at the heart of the work. 

“Sometimes the people that we work with have the best answers and solutions,” Torous said.