Digital Mental Health Encompasses More Than Telehealth

(Part 1 of 2)

Steven R Chan, MD, MBA, clinical assistant professor, Stanford University School of Medicine, California, and Gowri Aragam, MD, clinical instructor in psychiatry, Harvard Medical School, Boston, Massachusetts, sat down at the recent 2021 Psych Congress to discuss the current and future landscape of digital mental health (DMH). In this podcast, Dr Chan and Dr Aragam define DMH and explore how telepsychiatry fits into DMH such as increasing access, altering the patient-clinician relationship, and giving way for patient self-care.

Listen to part 2: Digital Mental Health Reduces Barriers and is ‘Not Going Anywhere’

Read the Transcript:

Dr Steven R Chan:  Hi, I'm Dr Steven Chan. I am a Psych Congress Steering Committee member, and I am on faculty at Stanford University School of Medicine, triple board-certified in Addiction Medicine, General Psychiatry, and Clinical Informatics. Dr Aragam?

Dr Gowri Aragam:  Hi, my name is Dr. Gowri Aragam. I am currently a consult-liaison psychiatry fellow at UCSF, formerly a staff at [Massachusetts General Hospital] MGH in Boston. I am also the co-founder of Stanford Brainstorm.

Dr Chan:  Dr. Aragam, we are so glad that you're here and we're having this conversation about digital mental health. The first question we have here is about describing digital mental health. Let's briefly describe what digital mental health is and how it's being woven into clinical practices.

Dr Aragam:  Awesome. You just gave a great talk on this exact topic, so why don't you take a stab at defining it?

Dr Chan:  Sure. We have a lot of different technologies out there, and I think of them in different categories—[there are] 2 sets that I'll present. One of them is the telehealth category, but it applies to other apps and technologies, too.

This is from the New England Journal of Medicine. They talk about clinician-to-clinician technologies, clinician-to-patient technologies, and then patient-self technologies or patient self-care. You can categorize all these technologies under those buckets.

Then, there's another set of technologies that we can categorize depending on how much evidence there is. Digital health encompasses a lot of different technologies. Then, there's digital medicine, which has more clinical evidence.

Then, there's digital therapeutics, which has a narrow indication, specific indication for curing, diagnosing, or treating a particular disease. Those are how I think of digital mental health technologies.

Dr Aragam:  That was a great summary of everything that I've thought of as well. The reason that this question is important is because for a long time, people hear the phrase digital health and they think telehealth, and, "Does digital health encompass everything? How do I get more precise? What applies to me?"

Being more precise with how we talk about this stuff also makes it easier for people to know what's going to be most relevant to them. It's cool.

Dr Chan:  The next question that we have is about telepsychiatry and fitting it in with digital mental health. How does telepsychiatry fit in with digital mental health?

Dr Aragam:  I want to interpret this in the way that I want to because it's exciting for me. I've always seen a lot of these digital tools for the past many years that have been coming out as ways to augment care, whether that's via telemedicine, or telepsychiatry, or in-person.

To me, telepsychiatry or being able to do something virtually, it's like someone walking in the door. It's like you're getting to see them, you're providing the care. You can do the typical thing, which is provide therapy, you can do medication management.

I’ve noticed that, even with my patients there has been more willingness for them to try other online tools once they got comfortable with the idea of talking to me online.

This idea of, "Oh, could you look this up or try this meditation, or look up this app?" There's a lot less barrier to trying things out, because they already have gotten a taste of it through the teleinterface, which is interesting in terms of how people learn.

Also, in general, it's like I'm always looking for what other tool I can use to provide the patient in that limited time that we have. If it's already decreasing the barrier when you have them online, it fits the bill to continue doing things that are virtual or that are asynchronous.

By that, I mean the patient can leave and work on things and come back to you. It helps both the clinician feel empowered to help the patient beyond those 30 minutes and it also helps the patient feel as though they're not just forgetting everything that was told to them in that moment, and then seeing their clinician either the week later or months later.

They can take more ownership and have a bit more control of their own care, which more and more people want nowadays.

Dr. Chan:  I like how you use the word asynchronous, which is a term that describes things that are [stormed] forward, not at the same time. I think we're all used to synchronous video visits for telepsychiatry.

Asynchronous telepsychiatry is a whole different ballgame, where you don't even have to have the doctor or the clinician there at the same time. It can free up a lot of the barriers, that scheduling barrier that can be an issue when it comes to synchronous video visits.

I also think of video visits—synchronous telepsychiatry and asynchronous as well—as something that's starting to blossom. We're also seeing this in the consumer world. Zoom filters that turn people into cats or something fun with stickers.

We're also seeing actual apps on Zoom that will help with inclusion and equity. For instance, closed captioning, language translation, and also other practical apps that can be built on top of the Zoom platform. Other platforms like Microsoft Teams also are seeing these augmented applications on top of video visits. It's a really exciting time.

Dr Aragam:  That's a great point. It's like the actual video itself, it's almost like we talk about augmented reality in Google Glass. In that vein, whether it's the closed captioning is a really important example that you just gave, because that in and of itself is a huge barrier to care in person, being able to have that interpreter.

Whatever you can do to augment the communication in that space is huge.

Dr Chan:  How many times have you had to wait for an interpreting service to arrive? There's a huge time barrier and availability barrier.

Dr Aragam:  Absolutely. Even with the virtual interpreters, which have been hugely helpful to have that available with an on-demand, which is being able to take one step further even and not have to rely on that person could be helpful, even if it's not here, but in other regions where you don't have access to that kind of thing.

[Music]

Dr Chan: If you want to learn more or want to reach out to us, you can reach me on Twitter @stevenchanmd, with an "A" "N" "M" "D", or you can also find my website, stevenchanmd.com.
Dr Aragam:  For me, you can find me on Twitter as well @gowriaragam, first name and last name, or you can also find me on LinkedIn.

Meagan Thistle, Psych Congress Network: Hello Psych Congress Network family, thank you so much for joining us. In the upcoming part 2, Dr Chan and Dr Aragam will discuss the following: the barriers in using digital mental health, the digital divide, 
and whether or not telespsychiatry and telehealth with continue to be widely used. Stay tuned and make sure to sign up for our e-newsletter to be the first to know when part 2 of this podcast is published. See you soon!

Dr Steven Chan (@StevenChanMD, www.stevenchanMD.com), is a Psych Congress steering committee member. He is a clinical informaticist and Medical Director for Digital Health, Addiction Consultation & Treatment at Palo Alto VA Health, and is a clinical assistant professor at Stanford University School of Medicine. Dr Chan is co-investigator on clinical research — on UC Davis asynchronous telepsychiatry and UCSF ADviCE Health, a digital health evaluation and outcomes platform.

Dr Gowri Aragam is a psychiatrist at Massachusettes General Hospital and co-founder of Stanford Brainstorm, the first academic laboratory for mental health innovation where she co-developed and directed a university-wide course of mental health product development. Dr Aragam has been a consultant for multiple tech companies, with her work featured in Wired and TechCrunch, and was a 2020 Fast Company Innovation by Design Finalist. Dr Aragam is currently a Scientific Advisor to BetterUp. Dr  Aragam was a Chief Resident at Massachusetts General Hospital/McLean Hospital. She received her MD from the University of Massachusetts and AB in Neurobiology from Harvard.