California Tests a Digital ‘Fire Alarm’ for Mental Distress

I’m really trying to weigh the pros and cons here. I keep getting tripped up by the privacy concerns. Every day we find out another way our privacy/data is being invaded/mined. The information being gathered here is, to me, what I would want guarded the most. It would be up to me as to whether I want to let anyone in my life know my mental state/diagnosis. However, if an individual is truly suffering, and this does prove to be helpful, then is risking privacy worth it? I’d love to know the decision making and thought process of people who chose to participate.

Me. Carey: did you neglect to mention Dr. Insel’s role at 7cups? Do you find it odd that he has roles at both companies and in the governors office? Technology such as software holds great promise but it doesn’t seem that California used an open or merit based process here....

Biofeedback has long been considered useful in treating mental illness. In that sense, this is new mostly in the sense that it can reach many more patients through smartphones. If I were still a practicing mental health therapist, I can see using Mindstrong in conjunction with counseling and therapy. However, it must guarantee a patient's privacy to the level that is now provided by human contact. 7Cups seems more like an employee assistance program in that it helps determine whether an individual needs referral for more personal help. That's a very different type of issue.

Dunno, have a lot of people I work with with mental health issues and this sounds a bit psychologically invasive and weird. Interned at SFO Suicide Prevention where crisis calls would come in as well as GGBridge red phones and we would try and calm down the callers and alert the PD. But all these taxpayer millions for someone with a mental health diagnosis that is rather routine and manageable and in all likelihood should still be able to pick up the phone and call their therapist.

Sounds like just the thing for people who suffer from paranoid schizophrenia or during a manic episode of bipolar disorder who already may fear machines are reading their thoughts. And people with severe depression already have problems performing any tasks. So essentially what this is for is the "worried well" who don't have any serious mental disorder. And states are always looking for a way to cut funding for mental health care and rather than be willing to hire more psychiatrists and pay them a going rate, they'd rather look for untried things like this. But it's not surprising about California using this as both Governor Newsom and his predecessor Jerry Brown both reduced state beds for the mentally ill claiming that psychiatric treatments were without value and did not benefit patients.

The idea that anyone is “unaware” of when their distress is very high is just idiotic.

So many people are "addicted" to their smartphones, it would seem that a clever app could create a desire to "interact" with the program to both provide necessary info for the study purposes, and a vital sense of control or consolation for the user. When a comparison was made to a fitbit -- I was thinking aha! some kind of a sensor which picks up on maybe, pulse rate, blood pressure, galvanic skin response or something else which would actually alert the individual wearing it - and record the time this happened. The the person could record, then or later, what sort of event happened. Some people love diaries; many of us like the idea but fail at the actual recording. To have a feel for this, I'm afraid that I'd need to see how it operates to get a feel for how it feels from the user's side. ( As a pre req-: all of the privacy and confidentiality issues have to be settled and clearly explained to any user. )

"The state is teaming up with Silicon Valley to make mental health services more available. Promises abound, and so do potential problems." The word "news" means what *happened* (that is of public interest). It does *not* mean what might or might not happen in the future. One might think that a "news organization" having so much trouble telling us *just what happened* might want to focus on that instead of what may or may not happen in the future. Guess not.

Borderline between what and what?

How odd- Tom Insel left the NIMH vowing to seek a better diagnostic & treatment system for mental illness, one based on neuroscience. He found psychotherapy, DSM5 and most current approaches inadequate. He just wanted something 'objective.' Now he is promoting a tech gadget for suicidal Borderline Personality patients ?? His niche was OCD--now, his 'solution' smacks of OCD: concrete, simplistic, mechanistic, non-relational. At least he isn't promoting portable ketamine nasal spray triggered by the app...or is he ?

Here's a fine way to reduce mental stress: Hire people for jobs that they are suited to; pay a living wage AND make sure there's housing people can afford across the board; make education a priority -- INCLUDING at the work place (not everyone is 100% literate -- give employees an opportunity to take classes in English, yeah, I said it.); Give people healthcare (affordable) either via insurance, or free services where appropriate. If an tenant loses a job, landlords should (are you ready for this one?) allow a temporary reduction in rents -- they're all rich enough. I could go on, but I'll be shot as a commie pinko socialist.

I think it's pretty ridiculous to for the top 1% to think they can help people with mental illness through this app. California is a failed state where housing is scarce, homelessness abounds, and the rich are getting richer. There have to be more practical solutions that involve real mental health teams reaching out to citizens rather than more apps.

Very interesting. I'd hoped the article would have provided a link to which of our counties here are part of the program. The downside I see is in reaching those who do not have consistent access to smart phones and/or the will to manage the digital mental-health protocols of the system. County mental health systems are already over-burdened. Will this slowly become a replacement to one-on-one brick & mortar counselling? And what will this model in serving the most vulnerable populations; the dual-diagnosis, homeless, foster youth...

This is, in principle, a good idea, and might well save people's lifes. As is often the case, the devil is in the details. A key challenge is how a patient's privacy will be protected; a non-negotiable especially in mental health, where stigma and discrimination are both real and strong. Just ask yourself: would you entrust information on something like mental illness to a company that tries to make money with such services? The only way forward that I believe would work is strong legal protection of people's health data significantly beyond HIIPA, the requirement for strong encryption and data protection, clear language on when law enforcement can have access, and what punishments can be given for violations of a patient's privacy. And by that, I mean not just high fines and monetary damages, but also hard time in the big house for severe violations. Again, a good, maybe even great idea, but it requires the legal framework to become more generally accepted.

I was surprised that this article doesn't address the so-called 'agency effect' in paranoid schizophrenia. This effect is sometimes associated with the urban legend (myth) of the tin-foil hat. Some believe that it is an unintended consequence of artificial intelligence (A.I.). The problem comes about because some people literally sense a "ghost in the machine" when they use their computers and smart phones. The 'agency effect' refers to the human ability to sense intelligent behavior in others. In untreated schizophrenia, for example, a person can hear voices and other artifacts of their unconscious mind, that literally seem to be beamed into them by an alien presence. Even normal people, when they experience artificial intelligence, will sense the effect. In the literature it is sometimes called the "uncanny valley effect". According to Reber and Reber (2009): "agency detection - in evolutionary psychology, the adaptive capacity to detect an agent. In prey species it aids in detection of predators and other dangerous agents so that evasive or defensive actions can be taken; in predators it enables spotting of prey. Phylogenetically, it is assumed that this capacity evolved early and is widespread among species." (p. 19) Cite: Reber, Arthur S., Rhiannon Allen and Emily S. Reber. The Penguin Dictionary of Psychology, 4th Ed. Penguin, 2009.

One significant problem in providing mental health services is the lack of trained providers. During the 2008 recession hundreds and thousands of people were struggling with depression and other mental health issues. There were not enough providers/mental health professionals available to help serve the increased demand. This app doesn't solve this problem.

I wish “experts” in the field of mental health would get it for a change. People, especially with mental health disorders need human connections, not an app, which keeps individuals isolated. It’s a connection, a hug, a looking into someone’s eyes and validating who they are, that can make a difference. I applaud California for at least acknowledging there is an issue, but bringing the wrong people to the table will not solve much.