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We’ve probably all seen the latest statistics: in the U.S. alone, approximately 25% of American experience a diagnosable mental health disorder every year, and yet, few people receive treatment. Worldwide, most people don’t receive any diagnosis or care for mental, behavioral or substance abuse problems. Our current healthcare systems simply aren’t adequately caring for those in need. Projecting into the future, how will we afford and improve care for billions of people suffering from behavioral problems?
This question is far from new. The latest set of answers started in the mid-70’s with early forms of managed care models. In effect, the current iteration of Health Care Reform began in those years, not only in the US, but in many other countries with experiments designed to get more timely, more effective and less costly interventions to many more people in need. As a result, outcomes have improved in many ways, but costs are spiraling and many health care system are still considered “broken” in the US, and worldwide. Now in the spring of 2014, we behavioral practitioners are just about to witness the largest change we’ve seen in our professional lives. Repercussions of the Affordable Care Act and many other supporting laws will soon begin to appear in behavioral and mental health arenas.
The above-described, profound shift in health care reimbursement policy is occurring at a time when technological capabilities are rapidly accelerating, and decreasing in costs. The behavioral and mental health words have not yet seen much change, but the next decade will bring unheralded change, whether or not professionals in practice today approve. The simple truth is that technology offers several possibilities to deliver some form of care that precedes and in many cases, can prevent the need for more direct care with a practitioner.
Evidence-based studies to look at such behavioral potentials have been funded by the US and other worldwide governments since the mid-50’s. They are now manifesting in viable products that serve as prototypes for a new class of interventions.
Robot Therapists: Telebehavioral Health Institute Blog
The Telebehavioral Health Institute blog will detail Health Care Reform, technological and reimbursement developments for you over the next months. We will also highlight other policy shifts that point to the way to unprecedented marketplace opportunities for creative and collaborative professionals who see what’s occurring around us, and want to be a part of it. The first profound change we’ll discuss in this blog has been developing in robot therapists, as led by mental health researchers in many settings across the globe.
The setting most recently visible is the University of Southern California, (USC) Institute for Creative Technologies (ICT). It recently announced SimSensei, a robotic prototype that is a “virtual interviewer.” It was named one of the year’s top 10 most promising digital initiatives by the NetExplo Forum. The following is a paragraph from the ICT announcement, visible from its blog.
SimSensei is a virtual human interviewer that can be used to identify signals of depression and other mental health issues. In recognizing ICT’s innovation, NetExplo’s organizers noted SimSensei’s potential as “a state-of-the-art tool that health care providers can use for screening and monitoring patients.”
SimSensei leverages ICT’s advances in developing interactive virtual humans — computer-generated characters that use language, have appropriate gestures, show emotion, and react to verbal and nonverbal stimuli. It also incorporates ICT’s MultiSense technology, which provides real-time tracking and analysis of nonverbal behaviors, including facial expressions, eye gaze, body posture and voice intonation.
From these signals, SimSensei can engage a user in conversation, follow up with appropriate questions based on an individual’s answers and body language, and use this data to infer signs of emotional distress. SimSensei is not designed for therapy or medical diagnosis, but it is intended as a support tool for clinicians and health care providers.
Where will these types of robot therapist developments lead? Do therapists need to feel threatened? Your comments are invited below. For the original article reporting this robot therapist technology, see this webpage.
Introduction to Telehealth Theory & Practice
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Depends upon how we define robots. The technological approach above will work for some, in the more near future than some of the things I discuss below. But not all people display emotional distress the same. (I would be interested in the programming AND the technology’s ability to “learn” and then incorporate that learning into individualized approaches in treatment.)
However, the biggest threat to traditional psychotherapy is “better” learning/information. Leading the charge is healthcare. Healthcare is making a huge shift that many do not acknowledge – a movement toward being and staying healthy and prevention. In the future, there will be programs in grade school (I am working on a program) that will teach resilience, pay much more attention to teaching coping mechanisms/skills, and enhancing ego strength. This, of course, will also be part of what current on-line self-help CBT (and other) treatment approaches will move into – prevention.
There is a sea change in healthcare with a strong focus on minimizing the number of people who ever get sick, both physical and psychological. Already much is being done to prevent illness (i.e., something as simple as vaccines and as complicated as genetic alteration – taking pro-active measures to identify genes associated with various illnesses and proactively taking actions to maximize that the illness will never occur. Of course, paying for keeping people healthy rather than paying providers to treat the sick (on a per procedure basis no less, which only encourages doing more treatment) will have a huge effect. Payment systems will reward those who foster good health, verified by outcomes measures. Prevention has never “paid” off for insurers in the past. Primarily because the benefits of such were generally experienced by a later health plan. (On average, Americans change their insurance carrier every 2-3 years.) With the ACA, people will be able to keep their insurance for as long as they want. And they will value health plans that keep them healthy and thus reduce the costs the individual incurs. Eventually, the cost of care will go down. Unless we decide to use every method available (many that people do not want such as ventilators, feeding tubes or other extreme measures for the situation) to keep people alive indefinitely.
Of course, people will argue nurture/environment is a part of disease development. So look for changes in those areas as well, in combination with better programs to teach children to be more resilient and have more effective coping strategies earlier in life. Mental health, just like physical/sexual health will eventually enjoy equal if not more priority status in being taught in our grade schools and even earlier. Parent training will be a part of the mix as well.
From a cost perspective, prevention will save a lot of money that would have gone to treatment. Yes, some people will get sick and need treatment. But I expect the % to decease over time (with the exception of the baby boomers given their ages and set ways). A decade or 2 from now, after the brain has been mapped, the “sky will be the limit”, in combination with genetics. We will continue to eradicate illness, just as we have for decades. However, our understanding of how genes and the brain work will lead to the eradication of diseases we never imagined could be eradicated. Bottom line: It is less expensive to prevent than treat. And yes, prevention will be a complex issue. But think of the time and money spent on trying to cure cancer or other catastrophic illnesses. If some of that time and money (including time and money from other areas) could be transferred to prevention I think we will see dramatic improvements in prevention.
For psychotherapists, the share of the market they have today will dwindle dramatically over the next few decades. That is one reason I and a few colleagues are writing a book on other roles mental health professionals can get involved in, from administration to working in prevention to teaching mental health in the schools.
I hope this comment sparks a hardy discussion. I have been in healthcare for 30 years, behavioral health, physical, and integrated physical and behavioral health. However, I do not see an expensive machine being the primary impact on behavioral health, including treatment. Prevention, prevention, prevention. And genetics and mapping the brain will move prevention forward at a staggering pace.
Of course it’s speculation, but I don’t think brain mapping will lead to therapies that replace psychotherapy in the next twenty years. At most, it will yield new adjunctive treatments like psychopharmacology now. Much research exists that shows talk therapy is effective. Because talk therapy is such a complex behavior, I have a hard time believing that it’s “active ingredients” can be replicated easily in another form.
It will be interesting to see where this tech goes. I think that the number of responses that clients need will always exceed the number of responses that these things can be programmed with. But of course, Jules Vern was told that submarines would never exist. Whether robots replace us or not, I think that they will be a valuable tool to help serve clients with access barriers to real therapists.