Opinion | Will Digital Technology for Therapy Increase Inequality in America?

But there are signs of progress.

I have been part of one such experiment: My research lab recently developed MoodText. It is a low-tech way to reach people who may not have access to home computers or endless phone data and help them to make the most of their group cognitive behavioral therapy sessions for depression. After sessions, MoodText will send automated messages to track patients’ moods and remind them of lessons that they learned in their sessions. We have found that the addition of the texting program doubled the number of sessions attended from three (nontexters) to six (texters) and greatly increased the number of weeks that patients stayed in treatment, from three to 13 out of a 16-week treatment. This type of intervention could be crucial since the dropout rate for therapy ranges from 20 percent to 60 percent and is especially high among low-income patients with competing life demands.

There have also been successes with app-based programs that focus on less stigmatizing approaches to improving mental health, such as those that encourage exercise. Physical activity can benefit a variety of health conditions, including mental health and depression symptoms via what we call “behavioral activation” or more plainly stated, improving mood by reducing isolation and increasing the chances of social interaction. That’s why a team of researchers that I have been working with developed and is testing Diamante, a machine-learning algorithm to personalize text messages to people, which they receive to encourage physical activity like walking. Importantly, this program is targeting English and Spanish speakers in a public sector clinic — the kind of place that is not typically the source of data for most machine learning and artificial intelligence algorithms.

Or look at [email protected], an initiative in California that — thanks to funds provided by the Mental Health Services Act — pays for mental-health services apps like Headspace, Mindstrong and iPrevail for people in underserved communities who might otherwise not be able to afford as much as $70 a year, which is how much Headspace costs. Additionally, the [email protected] initiative integrates feedback from patients and consumers of public mental health services to ensure that the apps are relevant to their lives.

To be sure, technology alone is not going to be a substitute for the more robust and equitable mental health care system that the United States needs. Our country needs to train more providers, particularly from communities with the least access to care. But that will take time. And even if we train providers, there will still not be enough to meet the needs of everyone, especially if the focus remains on traditional one-on-one psychotherapy. Digital technology can help increase access to mental health services. But only if we do it right.

Adrian Aguilera (@draguilera) is a professor in the School of Social Welfare at the University of California, Berkeley, where he directs the Digital Health Equity and Access Lab. He is also a professor in the department of psychiatry and behavioral sciences at the University of California, San Francisco/Zuckerberg San Francisco General Hospital, where he directs the Latino Mental Health Research Program and coleads SOLVE Health Tech.

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