The Need for a Mental Health Technology Revolution in the COVID-19 Pandemic

The current coronavirus 2019 (COVID-19) pandemic not only poses a large threat to the physical health of our population, if we fail to act now, it will also have detrimental long-term consequences for mental health. Though social distancing is a crucial intervention to slow down the destructive effects of the pandemic, it can lead to isolation, decreased physical activity, and increased rumination, which might particularly hurt those with pre-existing mental illness. Further, the stream of disheartening COVID-19 news provides fodder for increased worry and distress, which can be detrimental for people with anxiety disorders. Early cross-sectional surveys in the United States, Canada, and Europe show an increase in symptoms of depression and anxiety for the general population, associated with COVID-19 concerns (1). Thus, this crisis is exacerbating existing mental health conditions and creating conditions for the development of new ones. Further, if lessons from other outbreaks such as Ebola (2) and SARS (Severe Acute Respiratory Syndrome) (3) are any indication, even after an outbreak is controlled, there will likely be a substantial increase in need for psychological support. Crucially, this public health crisis will magnify and deepen existing shortcomings of mental health care systems. The US was already facing a mental health crisis before the pandemic: less than half of those with mental illness receive the care that they need (4). Underserved populations, such as low-income or ethnic minority populations, are disproportionately affected; they show the lowest utilization of mental health services (5). Early data suggest that underserved populations pay a larger health toll from COVID-19: they show higher mortality rates (6, 7). They are more likely to work in essential jobs putting them at greater risk of contracting COVID-19, and suffer greater economic consequences. All these factors lead to increased stress and anxiety. We will therefore be faced with an even greater relative shortage of trained professionals and means to mental health care during and after this pandemic. We argue that what we need during a public health crisis like this is a digital mental health revolution: scaling up the delivery of confidential mental health services to patients across a wide range of platforms, from telemental health to mobile interventions such as apps and text messaging. Here, we provide an overview of technological tools which could help to decrease the mental health burden of COVID-19, provide recommendations on how they could be used and scaled-up, and discuss considerations and limitations of mental health technology applications. Telehealth There is a crucial role for the use of teleconferencing software for therapy sessions during the COVID-19 pandemic. Most studies of teleconferencing services showed that effectiveness is comparable to in-person services across disorders including depression, posttraumatic stress disorder, and anxiety disorders (8). China has had some success with this approach. Researchers recently wrote in a Lancet Commentary that during the worst of the outbreak in January, China successfully provided online psychological counseling and self-help was widely rolled out by mental health professionals in medical institutions, universities, and academic societies (9). In the US, the pandemic has also catalyzed a rapid adoption of telehealth (10). Medicare now allows for billing for telehealth. Further, the Health Insurance Portability and Accountability Act (HIPAA) has been revisited to permit more medical providers to use HIPAA compliant platforms to communicate with patients. This removes a major barrier to wider adoption of telemedicine and could also provide an outstanding opportunity for patients who previously did not feel comfortable seeking mental health care to now approach these services. However, it is important to attend to disparities in technology access and digital literacy. Before the pandemic, only one in ten patients in the US used telehealth, and 75% said that they were unaware of telehealth options or how to access it (11). Recent data from primary care clinics showed that, though video care consults went up by 80% in late March and early April, minority groups represented a smaller portions of these visits (12). This is partly explained because of a lack of Internet availability, which varies due to limited data plans and lack of Wi-Fi, and inability to use smartphone features such as downloading apps (13). At the moment, some US telecom providers are offering free Internet services (14). However, longer-term strategies need to be developed to prevent further widening of the digital divide (15), including providing affordable, high speed Internet access, improving usability of telehealth programs, and providing appropriate guidance/training for patients using these services.