POTENTIAL DIGITAL HEALTH SOLUTIONS FOR MENTAL HEALTH DISORDERS DURING THE COVID — 19 PANDEMIC.

The Sars-Cov-2 virus has taken the world by storm. According to an unpublicized report by the Chinese Government , the first ever case of the novel coronavirus was reported on the 17th of November, 2020 in the city of Wuhan, China. Its potency wasn’t known. It was detected whilst their lunar New Year season was in full swing and a great amount of travel from to and fro China was seen. Now, it’s been a year and the stats are overwhelming. All over the world , around 58.7 million people have contracted the virus, 1.39 million of which are dead.

Countless counties are battling with this virus. Some have done so successfully like Vietnam. Countries like Britain and France are reeling under a second wave and have again imposed lockdowns. The United States of America (USA) despite having one of the most advanced healthcare systems in the world has lost over 250,000 of its citizens to the pandemic. The World Health Organization (WHO) has greatly emphasized a targeted response mechanism based on the country’s resources and for enhanced communication between countries to minimize the devastating impact of COvid-19. The importance of data collection for quicker invention of a vaccine is greater than ever.

This disease caused a direct impact on our healthcare system. The healthcare system in a developed country is so developed as to take in a specific number of patients with different ailments. They are not equipped to deal with hundreds of patients with the same disease all the while maintaining social distance for their frontline workers. Everyday. Undoubtedly, the system will collapse from stress. Where the healthcare system is not as well-developed ? Chaos would be a timid term to explain the situation.

Then there are those indirectly affected. It’s the damage that this disease has caused to our mental health. Covid-19 demands social distancing. Due to countries imposing sudden lockdowns and travel bans at a scale hitherto unheard of , the social isolation caused has been a huge problem all on its own. One of the most common phrases is “ Man is a social animal” and the lack of society has shown its adverse effects in humans.

Human beings have been emotionally driven due to isolation which has led to an unchecked sharing of misinformation. It’s being termed as “infodemic”. This has had negative consequences on the public mental health resulting in stockpiling of essential items for the fear of a lockdown and paranoia All of this results in depression, anxiety and panic attacks in many people.

MENTAL HEALTH & COVID-19

Covid is seen as reaching a peak in certain countries then the cases are seen declining for a while. Then again a resurgence is seen . This is referred to as the second wave of Covid. This has led many Governments to announce complete or partial lockdown again. These lockdowns cause social isolation and are accompanied by economical stressors like unemployment , deferred salary payments, defaulting of loans, a weakening global economy and whatnot.

This causes lack of stability in the psychosocial environment of an individual. It leads to two-fold disaster for the public mental health — Firstly , it may lead to onset of mental health disorders in individuals. And secondly it could exacerbate the existing mental health disorder that a patient is suffering from.

This pandemic has brought into stark light, the reasons for having a dedicated decentralized mental health services facility integrated in our healthcare systems. The availability and accessibility to quality mental healthcare is paramount to counteract pandemic driven mental health stressors.

Thankfully, effective usage of digital health solutions has been observed. This has helped offset the existing provision of mental health services and has been popular because its virtual nature adheres to the principle of social distancing. Several techniques involving technologies like Cloud Based Big Data Systems, Artificial Intelligence (AI) based chatbots, Online Health Communities (OHC) and Telehealth platforms are being used for remote consulting.

Cloud based Big Data Systems:

The potential of Big Data in this pandemic driven scenario is immense. Through the analysis of the data collected, Cloud based Big Data Systems can contribute in the following manner:

1. It can help in early detection of an outbreak . It can be done through a mere reading of the queries one types in during their online searches. It can also predict the possible locations of outbreaks by analyzing travel histories of the public , the demography of a region, etc.. It is through these analyses that the groups vulnerable to mental health disorders can also be narrowed down.
2. The big data obtained from social media can also be examined to identify potential at — risk individuals. The ubiquitousness of this data can be used to find recurring patterns to identify such behaviours.
3. The WHO Regional Office for Europe has adapted Germany’s COVID-19 Snapshot MOnitoring (COSMO) study protocol and questionnaire, and now offers support to its Member States to collect data. It’s been universally agreed upon that the vaccine for this disease would take time to be conceived. Therefore it’s important to prevent drastic measures like suicides or self-harm or being vulnerable to abuse or domestic violence that increased social isolation may bring out in a stressed individual. So analysing behavioural data in the face of the pandemic could help combat the above issues.
4. When it comes to individuals, big data can be used in the form of Ecological Momentary Assessment (EMA). For existing patients, EMA data can be recorded on tools like phones and further scrutinized to give relevant therapies or medications.

We can see that big data has helped shift the realm of healthcare from retrospective to real time and eventually to predictive healthcare tools. This could also mean mass surveillance for better data gathering of the public for mental health issues which raises an important ethical dilemma.

For a healthcare provider to base their diagnoses on such technologies, it is essential that the data collection method and parameters are robust and follow a defined diagnostic criteria. This would help in getting good quality data thus giving the doctor actionable intel to make more informed decisions.

AI Chatbots:

AI Chatbots make use of programs based on the principle of a decision tree thus creating automated conversations. They often use techniques like the National Language Processing (NLP) in their programmes. These characteristics are said to make them more interactive when compared to the traditional static digital repositories thereby leading to better patient engagement.

AI Chatbots like Wysa have been used for digital mental well being with demonstrative effectiveness in patients dealing with depression. The AI Chatbot Woebot has been used for Cognitive Behavioural Therapy (CBT) in young adults for depression and anxiety.

They have myriad applications in mental health promotion. In a situation like this pandemic, higher patient inflow can be dealt with the help of AI Chatbots to offset the patient — healthcare provider ratio. But these chatbots require oversight since they lack complete clinical accuracy.

These AI Chatbots could also perform a health “check-in” on the patients through conversations. This could prompt regular self-reporting in patients and eventually promote social inclusion as is seen in programmes like Social and Communities Opportunities Profile (SCOPE) scale which have been validated in the United Kingdom (UK).

They can also be equipped with a parameter driven “sorting mechanism” to separate out individuals who require a more detailed psychological support and then redirect them to the appropriate mental health services.

The challenges faced by AI Chatbots are not just technical or practical owing to their software centric nature . They also encounter socio cultural barriers . Most important of which is language. They need to have a dynamic language software that self-learns and adapts to the nuances in colloquialisms of the regional demography it caters to.

Online Health Communities (OHC):

These are digital platforms that are open to all , where patients and healthcare providers interact with each other. These interactions may or may not be anonymous depending upon the participants privacy concerns. The OHCs can be mobilised in the pandemic and do immense good.

1. As mentioned before, the “infodemic” has been a huge part of the COVID-19 crisis. Immense amounts of misinformation has flooded the internet, as a result crowding out relevant and official information. Here OHC can act as a death knell for fake information. OHCs are established platforms which can be used as “myth-busters”. This can generate a positive feedback loop that disables the vicious cycle of social isolation — misinformation — panic — paranoia.
2. Although tools like COSMO can be mobilized to analyze pandemic driven behaviours is an essential step to battle the pandemic, the behaviours in itself can be moderated by providing correct information and reducing paranoia. Herein OHC can help as it combines reputable sources and genuine concerns of patients thereby reducing anxiety greatly. For example Singapore created AskDr to counteract any rumour spread regarding the disease.

3. OHCs also take care of privacy issues where the identity of both the healthcare provider and the patient can be preserved. Also, OHC does not work on predictive but real time models and therefore collection of data through what can be termed as surveillance is not required.

Telehealth platforms for remote consultations:

Telehealth platforms have various personifications in the form of mobile health platforms, video-conferencing, store-and-forward technology, remote tele-monitoring with connected devices. When it comes to India, telehealth platforms have been greatly promoted by the Digital India programme.

Most importantly in the post COVID-19 scenario, tele-mental health services are a requisite for patient follow — up and review and also prescription refilling. Psychotherapy is an important practice which can be conducted by means of telehealth. This is one-on-one consultations. With the aid of video- conferencing, expert panels of varied specialities can also be set up timely to conduct an overall assessment of more complex cases.

WAY FORWARD:

Dealing with Covid-19 has brought forth stark realities for the mental health community. They need to intentionally deploy digital technologies so as to integrate themselves into the mainstream healthcare system to better tackle pandemic situations in the future.

For this to happen, patients and healthcare providers have to be made aware and educated accordingly to increase the acceptance of these services.

In the years that telehealth has been used, it was observed that the human component of doctor — patient interaction was crucial . Therefore these technologies need to be designed always keeping in mind the target population. But also it’s important to understand that when it comes to mental health , the “no size fits all” principle rules. So not only do these technologies need to be precise , but also flexible all the while being commercially viable.

Not only this, a clarity in the roles undertaken by the stakeholders in the process should be present. Doctors, patients, chief medical officers, hospitals and staff should be able to recognise their needs and responsibilities and be categorised based on their rank to make or influence decisions regarding the uptake of digital tools. This helps smoothen the dispensation of mental healthcare.