Why Evidence-based, Integrated Digital Companions are the Future of Mental Healthcare
This interview with Rosa Baños, Ph.D, is part of a larger series of interviews where we discuss the intersection of healthcare and technology with subject matter experts from Adhera Health’s Advisory Board.
Rosa Baños, Ph.D., is the most recent addition to Adhera Health's esteemed Advisory Board. A full professor of psychology at the University of Valencia, Rosa acts as the Director of the master’s program, “Multidisciplinary Intervention in Eating Disorders, Personality Disorders, and Emotional Disorders.” She has dedicated her career to the study of human psychology & disorders; her expertise is invaluable at Adhera Health as we address the bio-psychosocial factors that affect individuals afflicted with chronic conditions.
What are some of the most pressing global mental health challenges that you see happening today?
“There are really many, many challenges for this century,” says Rosa, “but if I have to choose two, I would highlight two that I think are very important. The first one is the access to psychological treatment.” Everyone deserves access to psychological treatment. “That one is a very important challenge. And the other is the prevention of mental disorders and the promotion of mental health.” As she explains, access to mental health care is a significant problem for people in both underdeveloped and developed countries. The barriers that exist are not only financial; a lack of healthcare infrastructure, limited numbers of health professionals, and “stigma” are all factors that limit an individual’s ability to get the care they need.
“I think that another important problem is the increasing prevalence of some mental health disorders, especially depression, anxiety, substance abuse; the figures are really very alarming… the all-around stigma surrounding mental health sometimes prevents people from seeking help and hinders their ability to receive the appropriate care.”
“And also, I think that treatments must be accessible, but also, we need treatments to be more available.” As Rosa explains, “That means we need greater integration between mental healthcare and primary healthcare, and also not only in the healthcare system but also into the daily life of the individual.”
You mentioned access, could you talk about that a little bit more, is it a lack of access? Is that what you're referring to?
“Yes, I say that because at least in Europe, more than 60% of the people with mental conditions don’t receive the appropriate treatment – we are talking about the first world, and we are talking about almost two-thirds of the population.”
“I always say in conferences or even to my students, imagine that if we are talking about another problem, imagine we're talking about oncological problems, for instance, saying that we have evidence-based treatments. We have effaceable treatments for this medical condition, for instance, diabetes or cancer – but almost two-thirds of the population are not receiving this kind of treatment. Within that, what is happening? It is really a very big problem.”
“And of course, sometimes it's because individuals don't know it is possible to recede this kind of problem. Sometimes people think that mental problems are something you must live with. You think that it's something about your weakness, it's not something that you can cope with in a successful way. This is one reason, of course. And of course, stigma is also another reason.”
As for the solution, Rosa points to the need for a more flexible mental health care system and suggests a critical reevaluation of our current treatment delivery methods. She cited a paper from 2011 that echoes her belief, explaining that even if we increase the number of mental health professionals fivefold, we still won't reach all the people in need.
“And they say that this is because our mental healthcare system is based on a one-to-one system. You know, one professional, one patient. Maybe one family, maybe one couple, maybe one group, but not more than that. So, we need another kind of treatment delivery because only one-by-one, it is impossible to achieve and to reach all the people in need.”
You've mentioned the difficulty of the one-to-one approach in mental health treatment. With the rapid advancements in artificial intelligence, do you think AI could potentially play a role in scaling individual mental health care?
“It's a very complex question,” Rosa notes that AI can perform certain tasks with great efficiency. “If you need some [specific] information for instance… artificial intelligence can be a very good answer.” But to Rosa, AI is a tool, and updating systems doesn’t mean replacing human beings. “The answer is not technologies substituting psychologists, psychotherapists, or psychiatrists. The answer is complimenting both. That's the point.” Nowadays, as Rosa explains, when you’ve got an issue with your phone bill and you call the phone company, “you want a human on the other side of the conversation.” What seems uncertain is if there will come a day when we won’t mind asking a robot for help, and how long that might take. “I don’t know how artificial intelligence will develop in the next five years; I think it’s very difficult to envision how the future will be in this aspect.” Fortunately for us all, Rosa still has faith in human beings, at least for now, “I think at this very moment we still need humans.” She laughs.
What do you think about the ways in which digital technologies (i.e., Calm or Headspace) are currently used in clinical practice to understand the mechanisms underlying mental health disorders? Are they providing meaningful mental wellbeing support?
One of the advantages of digital technologies is their ability to promote accessibility, “for instance, with mobile technologies,” which have the potential to “make mental health resources more accessible to a wider population.” Practically all it takes these days to receive up-to-date health education is an internet connection, says Rosa. “The interconnection of treatments in daily life is very important; at this moment we have the model that if you have a problem, you have to go to a doctor's office or a hospital to seek help.” Rosa believes that emerging technologies have the potential to shift this model to one that provides individuals with greater context for their health. “This care model will change,” says Rosa, “we are in that moment.”
These sorts of digital technologies have the advantage of “reaching many people and they are able to collect a large amount of data,” says Rosa. The bank of data helps clinicians and researchers to “gain insights regarding the underlying mechanisms of mental conditions. At this moment, we can monitor our patients in real time. We can track their moods, their behavior, and their physiological responses in real time. All this data contributes to a better understanding of the factors that influence mental health and wellbeing.”
One problem that Rosa sees with many of the current mental health applications on the market is that they aren’t necessarily evidence-based – “they cannot fulfill the things they promise,” she says. “Most of them are designed by a well-intentioned engineer, but one with not a lot of knowledge about psychology because sometimes people think that psychology is common sense.” Rosa thinks these sorts of applications can be damaging. “Many of these apps or digital interventions don't have research data evidence behind them. And that is very dangerous.” These sorts of applications lacking proper evidence can break people’s trust, says Rosa. “The market, it’s very quick… even the digital advances are quick.” It’s true that it can take time for regulations to catch up to the science, Rosa explains. “It’s not easy.”
Adhera Health hasn’t developed mental health-specific applications unlike other similar companies; we embed mental interventions within interventions for certain specific conditions. Do you think it would be more effective to have a separate application that would function solely as a mental health application?
“I am more in line with integrated care,” says Rosa. “We cannot consider health without mental health. So, from this perspective, care must also be holistic and integrated. It's not, this is for my physical wellbeing, this is for my mental wellbeing, and this is for my social wellbeing. No, I think the social aspect, the psychological aspect, and the medical aspects must be integrated and interconnected.” Because their condition varies over a long period of time, individuals afflicted with chronic conditions must follow an adaptable program. Psychological support, Rosa notes, is an important aspect of such a program. Rosa understands the perspective of the physician; that they may feel they are only responsible for the department that they are an expert in. However, as Rosa explains. “It’s the same department. I am one person, and everything is impacting me.” Holistic care requires a level of integration.
How would we engage in this integration in a way that would be more supported by clinicians, as they are ultimately the ones familiarizing patients with these new technologies?
We need to hear from clinicians, explains Rosa. “They also have their own needs, worries, concerns, and limitations. Sometimes it’s a problem of training… I, a psychologist, always say that we work from a biopsychosocial perspective. I can't understand inner illness without taking into account the social factors, the psychological factors, and the biological factors.” As Rosa explains, an integration of different disciplines is necessary and challenging, but emerging technologies pose an interesting solution.
How would you describe the difference between mental health and mental wellbeing, how are they interlinked?
“Well, mental health is a broader concept that includes mental wellbeing. Currently, in clinical psychology and psychiatry, we recognize that mental health has two dimensions: one refers more to the pathological aspects, including mental disorders; the other refers to wellbeing in terms of flourishing and personal growth. And these are two different dimensions, two distinct dimensions. Just not feeling well does not necessarily imply having a mental disorder. Of course, these are two dimensions that are closely related and correlated, but they should be promoted separately.” Understanding the difference in these terms can offer us a “more comprehensive” understanding of our own psychological state. “It’s recognized that mental health is not the absence of illness, but also the presence of positive factors that contribute to our optimal functioning. We need to prevent mental conditions. And this means to identify and to cope with risk factors, and also to have access to appropriate treatment and intervention.”
Rosa explains that we must be “fostering environments that support and care for people with mental conditions.” We must be promoting mental wellbeing, focusing “more on cultivating positive emotions” and building resilience through “positive relationships.” It isn’t just about avoiding risk factors, explains Rosa, it’s about creating a space to harbor sustainable personal growth, accountability, and commitment.
Why did you choose to be a member of the Adhera Health Board of Advisors?
“Why am I an advisor? Well because you were so kind.” Rosa laughs, speaking to the CEO of Adhera Health, Ricardo Berrios. “But really, I know the work you have done, and especially your sensibility to research.” For Rosa, an evidence-based approach is absolutely crucial. “I know a lot of digital companies that are developing apps very quickly for different things, and they're not interested in evidence. They're not interested in research.” As Rosa explained earlier, this can be dangerous. “For me, it's very great to work with people that are so responsible and so committed to ethics... this is a very important field,” says Rosa. As we all age, and as the average lifespan increases, addressing the chronic condition problem will become increasingly important. Rosa is proud that Adhera Health is addressing the problem with due diligence and passion. “I think it will be a successful future.”